Reliability and validity of the Dutch version of the Social Attributes of Dental Anxiety Scale

The aim of the present study was to assess the reliability and (factorial) validity of the Dutch version of the Social Attributes of Dental Anxiety Scale (SADAS). A factor analysis using the English version of the SADAS revealed two separate scales. The first eight items involved unwanted psychological upsets when patients encounter dental care directly; the four remaining items were about social inhibitions or restrictions due to the perceived state of oral health. Psychometric properties of the Dutch version were assessed using a sample of 170 highly anxious dental patients of a dental fear clinic in Amsterdam, The Netherlands. The Dental Anxiety Scale (DAS) and the Short version of the Dental Anxiety Inventory (S-DAI) were used as measures of dental anxiety. Factor analysis revealed that four factors explained 72.8% of the variance, and two forcedly extracted factors explained 53.4% of the variance. Correlations indicated that the SADAS does measure a different concept than dental anxiety. In addition, t-tests indicated that the SADAS was able to discriminate between a group of non-anxious individuals and the present group of patients. In conclusion, the SADAS is a promising new questionnaire with moderate factorial, but with more than sufficient reliability, as well as construct and discriminant validity.     

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.     

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.     

Stouthard牙科恐惧量表中文版的研制及评价

目的研制Stouthard牙科恐惧量表(Stouthard's dental anxiety inventory,DAI)中文版并对其心理学性质进行检验以评价量表的可行性。方法按照心理测量学中量表的跨文化适应程序对DAI英文版进行翻译、反译、文化调试和试用建立DAI中文版;并使用了DAS牙科焦虑问卷进行验证。使用DAI中文版对940例成人患者进行牙科恐惧调查,检验量表的信度、效度等心理测量学性质,且检测与Corah牙科焦虑量表(Corah's dental anxiety scale,简称DAS)和状态特质焦虑问卷(Stale-Trait Anxiety Inventory,简称STAI)得分之间的关系。结果 DAI中文版重测信度为0.943,内部一致性Cronbach'sα系数为0.956。结构效度KMO=0.961,因子分析共选出5个公因子:害怕医生的处理方式、对就医过程焦虑、一般牙科焦虑、害怕牙医及其评论和恐惧就医过程,其累计贡献率达60.541%。其分布与理论结构假设相符;DAI中文版与DAS和STAI中的特质焦虑量表得分呈显著相关(P<0.01)。结论 DAI中文版具有良好的信度和效度,是符合中国人使用的牙科恐惧量表。     

Development of a questionnaire measuring treatment concerns in regular dental patients

Abstract – Objectives: The aim of this study was to develop an instrument measuring core concerns about dental treatment guided by Reiss’ expectancy theory of fear. This would include the content domains of injury, somatic reaction and interpersonal concerns, to study the underlying factorial structure, and to determine the test quality of the resulting subscales. Methods: A total of 555 regular dental patients answered the item pool. Subsamples filled in the Dental Anxiety Scale (DAS) (n = 346) and the Anxiety‐Present Scale of the state‐form of the State‐Trait Anxiety Inventory (STAI‐S) (n = 187). A second sample (n = 89) was used to determine test‐retest reliability and bias for social desirability [Self Disclosure Scale of the Freiburg Personality Inventory (FPI)]. Results: Exploratory and confirmatory factor analyses identified a stable three‐dimensional structure underlying the items convergent to the content domains of interpersonal, injury and somatic reaction concerns. Internal consistencies of the resulting subscales were between α = 0.84 and α = 0.87, test‐retest reliabilities were from r_tt = 0.72–0.78. No evidence for a social desirability response bias was found. All subscales discriminated between patients with low and high dental trait anxiety at a level of P < 0.00001. Dental treatment concerns predicted 36% of variations in actual anxiety during treatment. Conclusions: The results suggest that the proposed instrument, namely the Dental Treatment Concerns Inventory, shows good test qualities according to construct, discriminant and predictive validity, and may be a promising tool for research and clinical applications.     

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.     

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.     

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.     

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

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

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.     

Appraisal of dental anxiety and fear questionnaires: a review

Abstract –This article reviews and assesses six dental anxiety and fear questionnaires. The construct aimed at by the questionnaires, the data collected, their reliability, validity and normative scores are considered. Some attention is given to the correlations between the questionnaires, their ambiguity, the presence of manuals, and whether the questionnaires tap the three segments distinguishable on theoretical ground in dental anxiety/fear. All questionnaires are open to criticism. In the final assessment Kleinknecht's Dental Fear Survey is preferred to Corah's Dental Anxiety Scale. The latter, however, appears useful in getting a quick impression of anxiety and in evaluative studies. Three recently developed questionnaires, Stouthard's Dental Anxiety Inventory, Weiner's Fear Questionnaire and Morin's Adolescents'Fear of Dental Treatment Cognitive Inventory are considered promising, but for the last two instruments more data, in particular with regard to their validity, are needed. H is concluded that in dental anxiety research more than one questionnaire should be used and that it may be worthwhile to include other, non-anxiety questionnaires as well.     

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 before removal of a third molar and association with general trait anxiety.

PURPOSE: The aim of the present study was to evaluate dental anxiety in patients consulting for third molar removal, and to assess possible relationships with general trait anxiety. MATERIALS AND METHODS: Dental anxiety was measured using Corah's Anxiety Scale (DAS), the Dental Fear Survey (DFS), and the state anxiety scale of the State-Trait Anxiety Inventory (STAI). Trait anxiety was measured with the trait anxiety scale of the STAI. RESULTS: Trait anxiety showed significant positive correlations with both DAS score and DFS score. The 3 measures of dental anxiety all showed significant positive correlations with each other. The difference between men and women was only statistically significant in the case of trait anxiety. CONCLUSION: These results suggest that trait anxiety may be a useful predictor of a patient's predisposition to dental anxiety.     

Psychophysiological reactions in dental phobic patients during video stimulation

Electromyography (EMG) reflecting forehead muscle tension, heart rate (HR) and skin conductance (SC) were continuously recorded in dental phobic subjects (n = 126) and controls (n = 25) during exposure of dental and neutral video scenes in order to explore the relationship between dental fear and psychophysiological responses. This relationship is far from well established, and the present investigation was performed to contribute to the understanding of the psychophysiology of dental fear. Dental phobics had a mean anxiety level of 17.3 as measured by Corah's Dental Anxiety Scale (DAS) and refused conventional dental treatment. Control subjects reported regular dental treatment and a DAS score below population average (DAS < 8). Psychophysiological data was reduced to level (mean) and reactivity (means of intraindividual variations). Results showed that physiologic reactions to fear-relevant conditions measured by HR and EMG reflected degree of dental fear, and that neutral conditions, when presented for the second and third time, induced lower psychophysiologic reactions in phobics than in controls. Recordings of SC indicated that dental phobics may differ from individuals suffering from other types of specific phobia by showing weakened autonomic responsiveness to threat.     

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.     

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.     

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.     

Attitudes to dental hygienists: evaluation of the Dental Hygienist Beliefs Survey in a Swedish population of patients and students

Abstract:  Objectives: The aim was to evaluate and test the psychometric properties of the Dental Hygienist Beliefs Survey (DHBS) in a Swedish sample of different patient groups and students. It was hypothesized that negative dental hygienist beliefs would discriminate between fearful and non-fearful study groups. The DHBS was distributed together with the revised Dental Beliefs Survey (DBS-R) and the Dental Anxiety Scale (DAS). The study sample included 394 subjects (130 students, 144 general dental patients, 90 periodontal patients and 30 patients on a waiting list for dental fear treatment). The results verified that the DHBS discriminates well between dentally fearful and non-fearful study groups. The DHBS had high internal consistency (Cronbach's α  = 0.96−0.98) in all the groups. The correlation between the DHBS and the DBS-R was high ( ρ  = 0.82, P  < 0.001). Furthermore, the DHBS correlated significantly with the DAS, as well as with a low but significant correlation to age (more negative attitudes in younger age groups) and gender (more negative attitudes amongst women). Regression analysis showed that gender and the DHBS items: 23, 16 and 28, i.e. items related to feeling helpless, worries/fears not being taken seriously and fear about 'bad news' possibly preventing treatment, were the most important predictors of dental fear. The results suggest that the DHBS may be a valid and reliable scale to use in order to assess patient's specific attitudes to dental hygienists. However, the psychometric properties including test–retest analysis and the underlying factor structure of the DHBS need to be further explored.     

Development of a computerised dental anxiety scale for children: validation and reliability

OBJECTIVE: To provide reliability and validity data on a computerised dental anxiety scale (the Smiley Faces Program or SFP) for children using faces as a response set. SETTING: Five schools across Derby, Newcastle-upon-Tyne and Shropshire. SUBJECTS AND METHOD: The SFP was completed by 464 children (mean age 10.8 years). For validity purposes, 241 children also completed two other children's dental anxiety measures (the Modified Child Dental Anxiety Scale and the Dental Fear Survey). For test-retest purposes 100 of the children completed the SFP two weeks later. RESULTS: The SFP demonstrated good internal consistency (alpha = 0.8), test-retest reliability was good and significant correlations were found between the SFP and the other measures. The children rated the local anaesthetic and drill as the most anxiety-provoking items. CONCLUSION: This study suggests that the SFP is a valid and reliable measure for assessing children's trait dental anxiety and may help encourage dentists to formally assess dental anxiety.