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.     

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

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

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.     

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.     

Psychometric properties of Spanish-language adult dental fear measures

Background  

It would be useful to have psychometrically-sound measures of dental fear for Hispanics, who comprise the largest ethnic minority in the United States. We report on the psychometric properties of Spanish-language versions of two common adult measures of dental fear (Modified Dental Anxiety Scale, MDAS; Dental Fear Survey, DFS), as well as a measure of fear of dental injections (Needle Survey, NS).     

What is the most fearful intervention in ambulatory oral surgery? Analysis of an outpatient clinic

The aim of this study was to evaluate the levels of fear and anxiety in patients undergoing different types of minor oral surgery procedures by using conventional rating scales adjusted to the population characteristics. A demographic form and translated versions of the Modified Dental Anxiety Scale (MDAS) and Dental Fear Survey (DFS) were completed by 500 patients having hard or soft tissue pathologies, third molar removal, implant placement, tooth extraction procedures and 200 non-clinical participants. MDAS and DFS were highly correlated (r=0.79; P<0.05). The structural properties of the MDAS were similar to the original, but the DFS required substantive changes to achieve comparable measurement properties. Anxiety levels decreased with age and were greater in females, those with higher education and following a previous unpleasant experience (P<0.05 for all). The third molar group scored higher than most of the surgical categories in both questionnaires (P<0.05 for each). DFS showed they tended to avoid surgical procedures and were more susceptible to environmental and chair-side effects (P<0.05 for all). Regarding oral surgery, third molar patients should be targeted to increase overall comfort of the treatment. Assessments should be adjusted to cultural differences.     

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.     

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.     

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.     

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.     

Statistical analysis of the "Dental Fear Questionnaire" surveying various subpopulations in Hungary

Authors investigated the Dental Fear Survey scores (DFS) of 362 persons from several subpopulations living in Budapest. Subjects were: 253 females, 109 males, aged 14 to 73 years. Scores of the items related to dental handpiece and anaesthetic needle were the highest. The group the participants belonged to influenced 19 items, marital status and age influenced 13 items, and sex influenced 10 items of the DFS significantly (one-way ANOVA, p < or = 0.05). Scores related to dental handpiece were higher than scores related to the anaesthetic needle, and the scores of the 20th item ("overall fear of dentistry") were near to the scores of most fearful items, indicating some "phobic character" of the Hungarian population.     

Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale

BACKGROUND: A new version of the Modified Child Dental Anxiety Scale (MCDAS) was formed by adding a faces rating scale to the original numeric form. AIMS: To describe the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDAS(f)), and to provide normative data for dental anxiety for children using the MCDAS(f). DESIGN: To determine the test-retest reliability, 287 schoolchildren aged 8-10 years completed the MCDAS(f) on two separate occasions 17 weeks apart. To determine the criterion validity, 207 schoolchildren aged 10-12 years completed the MCDAS(f) and the CFSS-DS at the same sitting. Construct validity was assessed using a cohort of 206 consecutive child dental patients and their parents. RESULTS: The MCDAS(f) showed good test-retest reliability (intraclass correlation coefficient = 0.80) and internal consistency (Cronbach's alpha = 0.82). The MCDAS(f) significantly correlated with the CFSS-DS (r = 0.80, P < 0.001). Dental anxiety assessed using the MCDAS(f) was related to the dmft (t = -2.17, P = 0.03), DMFT (t = -4.19, P < 0.001), and dental general anaesthetic experience (t = -4.46, P < 0.01). The mean MCDAS(f) score for the normative sample (n = 475) was 19.81 (95% CI: 19.20, 20.43). CONCLUSIONS: The MCDAS(f) is a reliable and valid measure of dental anxiety in children aged 8-12 years.     

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.     

Evaluating the validity of the Index of Dental Anxiety and Fear (IDAF-4C+) in adults with severe dental anxiety

Dental anxiety is a common condition with severe consequences for oral health and health-related quality of life. The aim of this study was to evaluate the recently developed self-report scale Index of Dental Anxiety and Fear (IDAF-4C⁺) in adults with severe dental anxiety. A sample of 147 adults (age 20–71 yr) with severe dental anxiety completed a questionnaire including the IDAF-4C⁺ and three other dental anxiety scales. In a clinically assessed subgroup (n = 93), 95% had an International classification of diseases and related health problems 10th version (ICD-10) diagnosis of specific phobia for dentistry. Agreement between the scales was analysed using Spearman’s correlation, the Kappa measure of agreement and the intraclass correlation coefficient. The agreement of dental phobia according to the IDAF-4C⁺ phobia module and the ICD-10 was very low (ĸ = 0.02). The anxiety and fear module of the IDAF-4C⁺ showed acceptable agreement with the other scales (r_s 0.69–0.75; ICC 0.90, 95% CI 0.87–0.93). We conclude that the IDAF-4C⁺ offers more information to clinicians and researchers than the older dental anxiety scales, but the phobia module needs further development.     

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.     

Validity and Reliability of the Vietnamese Version of the Dental Fear Survey

ObjectivesThe use of questionnaires to assess patients’ dental fear is critical to dental research and practice. As one of the most well-established tools in this field, the Dental Fear Survey (DFS) was translated into Vietnamese (V-DFS) and employed in previous studies. However, its validity and reliability have not been reported. This study aimed to determine the validity and reliability of V-DFS in adults.MethodsThe DFS was translated to Vietnamese in accordance with the “Guideline for the Process of Cross-cultural Adaptation of Self-reported Measures” to create the V-DFS. Next, 414 students at Pham Ngoc Thach University of Medicine completed the V-DFS to examine its validity and reliability. The factorial validity of V-DFS was assessed using exploratory factor analysis (EFA) and structural equation modeling (SEM). The internal consistency and test-retest reliability of the V-DFS were assessed using Cronbach's alpha (α), intraclass correlation coefficient (ICC), and Spearman's rank-order correlation coefficient (r_s).ResultsThe rotated component matrix of the EFA revealed 3 factors: specific stimuli, anticipatory fear and avoidance, and physiologic arousal. The statistical indices of the best-fitting V-DFS model in SEM analysis satisfied the cutoff values. Cronbach's α ranged from .82 to .94 for the 3 factors. The ICC and r_s of the whole questionnaire were .86 and .86, respectively.ConclusionsDFS was successfully translated into Vietnamese with good validity and reliability. Further research should be conducted to examine its validity in various populations and to improve its characteristics.     

Reliability and cross-cultural validity of a Japanese version of the Dental Fear Survey

Background  

This study established the reliability and cross-cultural validity of a Japanese version of the Dental Fear Survey (DFS).     

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.     

Dental anxiety and symptoms of general anxiety and depression in 15‐year‐olds

Abstract: Objectives: The objective of the study was to analyse the relationship between dental anxiety and symptoms of general anxiety and depression among 15‐year‐old individuals. Methods: The sample analysed included 221 randomly selected 15‐year‐old individuals living in the city of Jönköping, Sweden. One questionnaire captured sociodemography and dental history, while dental anxiety was assessed by the Dental Fear Survey (DFS) and symptoms of general anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). Results: About 6% of the adolescents were classified as dentally anxious. Symptoms of general anxiety and depression were significantly correlated with dental anxiety in both the bivariate and multivariate analyses. The latter analyses were adjusted for gender and previous painful experiences of dental care. Individuals with high dental anxiety showed general anxiety scores on a clinical level (mean = 9.8, SD = 4.3). Conclusions: Symptoms of general anxiety and depression were shown to be significantly correlated with dental anxiety among 15‐year‐old individuals.     

Concomitant and discriminatory validity of the Adolescents' Fear of Dental Treatment Cognitive Inventory

The revised edition of the Inventaire cognitif de la peur des traitements dentaire pour adolescent(e)s [Adolescents' Fear of Dental Treatment Cognitive Inventory] (ICPTD-A) was administered to 38 subjects chosen at random and to nine subjects chosen with an obvious dental phobia problem. Its concomitant validity was established by relating the ICPTD-A scores to those of a behavioral test. The Pearson correlation coefficients that were thus obtained were -0.66 for the general population and -0.87 for the population suffering from dental phobia. The discriminatory validity was then established with a repeated measurement variance analysis based on the scores of the dental phobics after the administration of a recognized psychological treatment program intended to reduce their phobia. The results have shown a statistically significant difference between the experimental and control groups as well as a significant difference between pre- and posttreatments. The authors have therefore concluded that the ICPTD-A is a valid tool for the assessment of dental phobia in 12-15-year-old adolescents.