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Dental Anxiety, Dental Visits and Oral Hygiene Practices

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Abstract

Purpose: The present study investigated the effects of dental anxiety and dental visits on oral hygiene practices, which included brushing, flossing and amount of time brushing. Materials and methods: The study included a dental questionnaire developed to measure aspects of dental visits, oral hygiene and dental anxiety. A demographic questionnaire included questions pertaining to age, ethnicity and citizenship. Participants included 77 undergraduate students attending a diverse southern United States university enrolled in psychology courses. Results: Linear regression was conducted to explore the association between dental anxiety and oral hygiene practices. Results revealed the model explained a significant proportion of variance in oral hygiene practices, R2 = 0.141, F(1,76) = 12.441, P < 0.001. Specifically, higher dental anxiety was associated with poorer oral hygiene practices. A correlation was conducted to investigate the association between dental visits and oral hygiene practices. Results revealed a correlation between dental visits and brushing r(75) = 0.342, P = 0.002, and flossing frequency r(75) = 0.294, P = 0.009. There was no association between visits to the dentist and time spent brushing teeth. Conclusion: Results indicate that dental anxiety is associated with oral hygiene practices. Additionally, those who visit the dentist more often have somewhat better oral hygiene practices. The present study indicates that there may be a learned association between dental anxiety and oral hygiene practices. Methods of education can be developed to disassociate anxieties that may inhibit optimum oral hygiene practices. It may also be beneficial for dental professionals to emphasise the value of the amount of time patients spend brushing their teeth.
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Vol x, No x, 20xx 1
ORIGINAL ARTICLE
Dental anxiety is a signicant problem for pa-
tients and dental care providers. Anxiety often
causes patients to avoid necessary treatment, and
once in the dental chair, they often are difcult to
treat (Lahmann et al, 2008). The question arises
as to what extent dental anxiety effects activities
beyond the dental ofce, such as personal oral hy-
giene practices. Identifying factors that impact oral
hygiene practices is of signicant value, since non-
compliance with oral hygiene recommendations is
a major problem in preventive dentistry (Sniehotts
et al, 2007). Good oral hygiene practices take only
minutes a day and save more than $4 billion per
year in treatment costs (Dolatowski, 2008).
Dental Anxiety, Dental visits and Oral Hygiene Practices
Michael A. DeDonnoa
Purpose: The present study investigated the effects of dental anxiety and dental visits on oral hygiene practices which
included brushing, ossing and amount of time brushing.
Materials and Methods: The study included a dental questionnaire developed to measure aspects of dental visits, oral
hygiene and dental anxiety. A demographic questionnaire included questions pertaining to age, ethnicity and citizenship.
Participants included 77 undergraduate students attending a diverse southern United Sates university enrolled in psy-
chology courses.
Results: Linear regression was conducted to explore the association between dental anxiety and oral hygiene practices.
Results revealed the model explained a signicant proportion of variance in oral hygiene practices, R2 = 0.141,
F(1,76) = 12.441, P < 0.001. Specically, higher dental anxiety was associated with poorer oral hygiene practices. A
correlation was conducted to investigate the association between dental visits and oral hygiene practices. Results re-
vealed a correlation between dental visits and brushing r(75) = 0.342, P = 0.002, and ossing frequency r(75) = 0.294,
P = 0.009. There was no association between visits to the dentist and time spent brushing teeth.
Conclusion: Results indicate that dental anxiety is associated with oral hygiene practices. Additionally, those who visit
the dentist more often have somewhat better oral hygiene practices. The present study indicates that there may be a
learned association between dental anxiety and oral hygiene practices. Methods of education can be developed to disas-
sociate anxieties that may inhibit optimum oral hygiene practices. It may also be benecial for dental professionals to
emphasise the value of the amount of time patients spend brushing their teeth.
Key words: behavioural decision making, dental anxiety, dental visits, learned association, oral hygiene practices
Oral Health Prev Dent 2012;10: 1-5 Submitted for publication: 16.06.11; accepted for publication: 20.10.11
a Assistant Professor, Department of Psychology, Barry University,
Miami Shores, Florida, USA.
Correspondence: Dr. Michael DeDonno, Department of Psychology,
Barry University, 11300 NE 2nd Avenue, Miami Shores, FL, 33161
USA. Tel: +1-305-899-3273, Fax: +1-305-899-3279. Email: mdedon-
no@mail.barry.edu
Dental anxiety consists of a number of compo-
nents and refers to a high degree of fear or anxiety
associated with dentistry (Locker, 1996). A patho-
logical form of this fear is variously called dental
phobia, odontophobia, dentophobia and dentist
phobia. Dental anxiety is generally manifested
through negative past experiences with the dentist
or vicariously through negative perceptions of the
dentist. Research on dental anxiety generally fo-
cuses on prevalence, impact on dental health and
impact on oral health quality of life. The prevalence
of dental anxiety ranges from 4% to 20% (Locker,
1996; Raque, 2008). In milder forms, it is esti-
mated that as many as 75% of US adults experi-
ence some degree of dental anxiety (Agdal, 2010).
Research on the association between dental
anxiety and the impact on dental health includes
direct effects (Bare and Dundes, 2004) and treat-
ment (Berggren, 2001; McGarth and Bedi, 2003). A
direct effect of dental anxiety is a tendency to avoid
recurring treatment and to only seek care for emer-
gencies such as a severe toothache or dental ab-
DeDonno
2 Oral Health & Preventive Dentistry
scess (Armeld, 2010). Many times, anxious pa-
tients lose teeth that otherwise could have been
saved with routine restorative or periodontal treat-
ments but, due to delays, can no longer be restored.
Researchers have found associations between
dental anxiety and oral health. Specically, individu-
als with higher dental anxiety self-report poorer oral
health than those with lower dental anxiety (Arm-
eld et al, 2007). It has also been reported that
higher dental anxiety is associated with more de-
cayed teeth (DT) and missing teeth (MT; Armeld et
al, 2009).
The impact of dental anxiety on daily life has also
been of interest (Raque et al, 2008). The Center
for Disease Control (CDC) states that missing teeth
can contribute to poor diet and to embarrassment
resulting in diminished social interaction and com-
munication (CDC, 2004). The Oral Health Quality of
Life (OHQoL) scale is a 16-item self-reporting meas-
ure that explores the physical (e.g. eating, appear-
ance, breath), social (e.g. relationships, work, -
nances) and psychological (e.g. sleep, condence,
mood) aspects of dental anxiety. It has been shown
that those persons with the highest levels of dental
anxiety have the poorest OHQoL: individuals with
high dental anxiety are two to three times more
likely to have a low OHQoL score than those having
low anxiety (Raque et al, 2008). The same study
(Raque et al, 2008) found an association between
OHQoL and sleep, personal relationships and -
nances. However, current research has not investi-
gated the effects of dental anxiety on personal oral
hygiene habits.
Plaque is a primary factor in gingivitis and perio-
dontal disease (Greenstein, 1992), but plaque con-
trol prevents these diseases. In addition, brushing
and ossing remove plaque and contribute to the
prevention of dental caries, in which the delivery of
uoride by toothpaste provides the major cariostat-
ic effect (Choo et al, 2001). Current oral hygiene
measures include mechanical aids such as tooth-
brushes, oss, interdental cleaners and chewing
gum. Chemotherapeutic agents such as mouthrins-
es and dentifrices are also used in personal oral
hygiene.
In 2007, health care spending for dental servic-
es was $95.2 billion in the US (Centers for Medic-
aid and Medicare Services, 2007). Conventional
treatment of oral diseases as just described is
costly and not feasible in many low-income coun-
tries (WHO, 2003). Fortunately, most oral diseases
can be prevented through proper oral hygiene prac-
tices (Davidson et al, 1997), and the cost of provid-
ing preventive dental treatment is estimated to be
10 times less than the cost of managing symptoms
of dental disease in an emergency room (Pettinato
et al, 2000).
The purpose of the present study was to explore
the effects of dental anxiety and dental visits on
oral hygiene practices. The study addresses the fol-
lowing questions: 1) Do dentally fearful individuals
practice better personal oral hygiene than dentally
non-fearful individuals? and 2) Will individuals who
visit the dentist more often have better oral hygiene
practices than those who visit the dentist less of-
ten?
MATERIALS AND METHODS
The present research protocol was approved by the
Institutional Review Board (IRB) and all participants
reviewed and signed a research consent form. Par-
ticipants were undergraduate students attending a
diverse private Southern US university who were
enrolled in introductory psychology courses. Partici-
pants were free to choose from a series of research
studies and received course credit for participating.
A total of 77 participants completed the dental
questionnaire, 57 females and 20 males with an
average age of 21.4 years (SD = 3.9). The sample
included 30 African Americans, 30 Hispanics and
17 Whites. A total of 44 participants were US-born
while 23 participants were born outside the US.
The present study included a dental and demo-
graphic questionnaire. The dental questionnaire
was a self-report scale developed to measure as-
pects of dental visits, care, oral hygiene, past expe-
riences and dental anxiety. To gauge dental visits, a
question was asked pertaining to frequency of year-
ly dental visits. Participants were asked about past
and current orthodontic and cosmetic treatments.
They were also asked (best guess) to report the
number of cavities and or llings they had. Oral hy-
giene practices were based on three questions:
how often do you brush your teeth, how often do
you oss and, when you brush your teeth, how long
do you brush? To gauge past experience, two ques-
tions were included to determine any negative ex-
periences during a dental visit. One question asked
about painful experiences during a visit, while the
second question asked about unpleasant experi-
ences (e.g. did not like the dentist or dental hygien-
ist) during visits.
To assess dental anxiety, the present study used
a modied dental anxiety scale. Similar to Corah’s
DeDonno
Vol x, No x, 20xx 3
Dental Anxiety Scale, the scale used here included
typical items relating to feelings during a dental ap-
pointment (Kumar et al, 2009). However, this modi-
ed version included an item pertaining to feelings
days to weeks before the actual appointment. Re-
searchers have found that general anxiety increas-
es as the time draws closer to the event (Jones and
Cale, 1989). It is possible that current dental anxi-
ety scales not only capture dental anxiety but gen-
eral anxiety as well. Therefore, it is important to
collect information about feelings well in advance
of the event to minimise the effect general anxiety
may play on dental anxiety. Inclusion of an item re-
lating to feelings well before the event could also
further discriminate levels of dental anxiety among
the participants. The modied dental anxiety scale
was a Likert-type self-reporting measure with val-
ues ranging from 0 (no anxiety) to 5 (very high anxi-
ety). The scale included the following four ques-
tions: what’s your level of anxiety when making an
appointment with the dentist (days to weeks before
actual appointment), what’s your level of anxiety
when travelling to the dentist appointment, what’s
your level of anxiety when waiting in the dental of-
ce and what’s your level of anxiety when sitting in
the dental chair? Results for each question were
combined to obtain an overall dental anxiety score.
The dental anxiety scale used here did not fulll
diagnostic criteria for a dental phobia as stated in
the Diagnostic and Statistical Manual of Mental
Disorders, 4th edition (DSM,IV; APA, 2000). As a
result, typical behavioural patterns were not identi-
ed (e.g. missing appointments) and a cutoff point
was not dened.
The demographic questionnaire included ques-
tions pertaining to age, ethnicity and citizenship.
The questionnaires were distributed in a paper for-
mat and completed in a group setting in a standard
classroom. Participants were given ample time and
instructed to complete the questionnaires to the
best of their ability.
RESULTS
Exploratory analysis revealed 82% of the partici-
pants brushed their teeth two or more times per
day and, when brushing their teeth, 54% brushed
for at least two minutes. With regard to ossing,
27% ossed their teeth at least once a day and
65% of the participants reported having fewer than
four cavities and/or llings. Relating to dental work,
47% of the participants visited the dentist at least
twice a year. 59% of the participants reported hav-
ing had orthodontic treatment while 86% reported
having had cosmetic (e.g. teeth whitening, veneers,
etc.) work performed.
To explore the reliability of the modied dental
anxiety scale, a Cronbach’s reliability analysis was
conducted. The analysis included the four items
that assessed the participant’s feelings when mak-
ing a dental appointment, driving to the dentist’s
ofce, waiting in the dentist’s ofce and sitting in
the dentist’s chair. The analysis revealed a high reli-
ability (α = 0.943) for the dental anxiety scale. To
evaluate the validity of the dental anxiety scale, a
linear regression was performed. The dependent
variable was the number of annual dental visits,
while the predictor variable was the dental anxiety
score. It was anticipated that a higher score on the
dental anxiety scale would be associated with few-
er visits to the dentist. As expected, the overall
model explained a signicant proportion of the vari-
ance in the number of annual visits to the dentist
R = 0.31, R2 = 0.099, F(1,76) = 10.340,
P = 0.005. Specically, higher dental anxiety scores
were associated with fewer visits to the dentist. To
further evaluate the validity of the dental anxiety
scale, an additional linear regression was conduct-
ed. The dependent variable was dental anxiety
score while the predictor variables were past pain-
ful and unpleasant experiences with the dentist. It
was anticipated that a higher score on the dental
anxiety scale would be associated with past painful
and unpleasant dental experiences. As expected,
the overall model explained a signicant proportion
of the variance in the anxiety score, R = 0.295,
R2 = 0.087, F(2,77) = 3.576, P = 0.033. Specic-
ally, individuals who could recall past painful or un-
pleasant dental experiences had higher dental anx-
iety.
To explore the inuence of dental anxiety on oral
hygiene, a linear regression was conducted. The de-
pendent variable was oral hygiene practices while the
predictor variable was the dental anxiety score. Oral
hygiene practices were the sum of three items, brush-
ing and ossing frequency plus amount of time spent
brushing. Responses to brushing frequency ranged
from a few times to a month to more than twice a
day, and ossing frequency ranged from a few times
a year to more than twice a day. The amount of time
spent brushing ranged from less than one minute to
more than three minutes. Results revealed that the
overall model explained a signicant proportion of
the variance in oral hygiene practices: R = 0.375,
R2 = 0.141, F(1,76) = 12.441, P = 0.001. Specic-
DeDonno
4 Oral Health & Preventive Dentistry
ally, higher dental anxiety was associated with poorer
oral hygiene practices.
In order to assess the association between visits
to the dentist, daily brushing and ossing and time
spent brushing, a correlation analysis was conduct-
ed. A correlation was found between dental visits
and frequency of brushing (r(75) = 0.342,
P = 0.002) and ossing (r(75) = 0.294, P = 0.009).
Specically, the more participants visited the den-
tist, the more they brushed and ossed on a daily
basis. A correlation was not found between visits to
the dentist and time spent brushing teeth
(r(75) = 0.134, P = 0.241). Individuals who visited
the dentist more often did not seem to spend more
time brushing their teeth than those who visited the
dentist less often.
DISCUSSION
The major ndings can be summarised as follows:
1. Dentally fearful individuals practiced poorer oral
hygiene than those with lower levels of dental anxi-
ety; 2. Individuals who visited the dentist more of-
ten had somewhat better oral hygiene practices
than those who visited the dentist less often.
Dentally fearful individuals practiced poorer oral
hygiene than those with lower levels of dental anxi-
ety. Classical conditioning demonstrates that indi-
viduals develop conditioned responses to an event,
for example, the famous study conducted by Ivan
Pavlov demonstrated that a dog could develop the
conditioned response of salivating when hearing
the sound of a bell (McSweeney and Bierley, 1984).
If you were to think of your favorite food for exam-
ple, be it strawberries, chocolate or maybe curry, it
would not be surprising if you began to salivate.
Through experience, you have learned to love this
food and this learned association has caused you
to salivate (Eysenck, 2004). Individuals can associ-
ate a physiological response to a negative or posi-
tive event with cues that remind them of the event
(Reid et al, 2008). For example, research has
shown that the physiological response due to con-
sumption of a drug can occur when the individual
handles something that is reminiscent of the drug
(Reid et al, 2008). Through experience, the individ-
ual learns to associate the feeling felt when using
the drug with such things as the location where the
drug is consumed and the drug paraphernalia. Sim-
ilarly, individuals who feel anxiety when visiting the
dentist may learn to associate those negative feel-
ings with oral hygiene practices. As a result, the
individual may not only avoid the dentist, but any
cue (i.e. brushing and ossing) that is associated
with the dentist.
Individuals who visit the dentist more often have
somewhat better oral hygiene practices than those
who visit the dentist less often. During dental ap-
pointments, dentists and hygienists instruct pa-
tients on proper oral hygiene such as daily ossing
and brushing for at least three minutes twice a day
(CDA, 2005). As a result, it is no surprise that indi-
viduals who choose to visit the dentist more often
brush and oss more than those who visit the den-
tist less often. However, the lack of an association
between amount of time brushing teeth and visits
to dentists warrants further consideration. Two pos-
sibilities could explain this result. First, dental pro-
fessionals may not be informing their patients of
the importance of the amount of time spent brush-
ing teeth. Second, patients are being informed, but
choose not to follow the recommendation. The lat-
ter could be due to patients not believing the addi-
tional brushing time is really necessary. It may be
benecial for dental professionals to further em-
phasise the value of time spent brushing, as well
as frequency, for thorough plaque removal.
The present study explored the effects of dental
anxiety and dental visits on oral hygiene practices.
A strength of the study is its general applicability to
the broader US ethnic population which consisted
of Blacks (39%), Hispanics (39%) and Whites (22%).
Some limitations of the research were that there
were a limited number of male participants (26%)
and only undergraduate students from a private,
Southern US university were included in the pre-
sent research. As noted by Mertz and O’Neil (2002),
dental disease recognises few barriers of class,
ethnicity or economic status, so a larger sample
may have provided insight into any potential ethnic
or socioeconomic differences in dental anxiety. In
summary, the importance of understanding dental
anxiety is evident not only as it relates to dental
visits but to all oral hygiene practices.
CONCLUSION
The present study indicates that dental anxiety and
dental visits are associated with oral hygiene prac-
tices. Theoretically, the present study indicates that
there may be a learned association between dental
anxiety and oral hygiene practices. Practically,
methods of education can be developed to disas-
sociate anxieties that may inhibit optimum oral hy-
DeDonno
Vol x, No x, 20xx 5
giene practices. Further, dental professionals may
consider emphasising the value of the amount of
time patients spend brushing their teeth.
ACKNOWLEDGEMENTS
The author would like to thank Lisa C. Elias DMD for her assistance
with development of research materials. The author would also like
to thank Karla Rivera Torres for her assistance with data collection.
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... Negative experiences with dentists in adulthood and especially in the vulnerable phase of childhood can cause dental anxiety [17,18]. Dental anxiety can later lead to avoiding visits to the dentist and affect oral health and oral health behaviour [19,20]. Parental oral health behaviours, including frequency of toothbrushing and dental visits, dental anxiety, self-perception of one's own oral hygiene, caries experience, attitude towards oral hygiene, oral hygiene related self-efficacy perception and maternal care have an effect on children's frequency of toothbrushing and dental visits and dental anxiety [21][22][23][24]. ...
... In terms of oral health measures, dental fears were associated with a negative attitude towards brushing and reduced control of their own teeth. The links between dental fears and poor oral health and hygiene can be confirmed [19,20,55]. These results turned out that child-oriented and patient-centred dentistry and sufficient analgesia during patients' treatment could contribute to a better relationship to the own oral cavity and possibly also to a higher motivation for oral hygiene procedures. ...
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Many preventive approaches in dentistry aim to improve oral health through behavioural instruction or intervention concerning oral health behaviour. However, it is still unknown which factors have the highest impact on oral health behaviours, such as toothbrushing or regular dental check-ups. Various external and internal individual factors such as education, experience with dentists or influence by parents could be relevant. Therefore, the present observational study investigated the influence of these factors on self-reported oral heath behaviour. One hundred and seventy participants completed standardized questionnaires about dental anxiety (Dental Anxiety Scale (DAS), and dental self-efficacy perceptions (dSEP)). They also answered newly composed questionnaires on oral hygiene behaviours and attitudes, current and childhood dental experiences as well as parental oral hygiene education and care. Four independent factors, namely attitude towards oral hygiene, attitude towards one’s teeth, sense of care and self-inspection of one’s teeth were extracted from these questionnaires by rotating factor analysis. The results of the questionnaires were correlated by means of linear regressions. Dental anxiety was related to current negative emotions when visiting a dentist and negative dental-related experiences during childhood. High DAS scores, infantile and current negative experiences showed significant negative correlations with the attitude towards oral hygiene and one’s teeth. Dental anxiety and current negative dental experiences reduced participants’ dental self-efficacy perceptions as well as the self-inspection of one’s teeth. While parental care positively influenced the attitude towards one’s teeth, dental self-efficacy perceptions significantly correlated with attitude towards oral hygiene, self-inspection of one’s teeth and parental care. Dental anxiety, dental experiences, parents’ care for their children’s oral hygiene and dental self-efficacy perceptions influence the attitude towards oral hygiene and one’s own oral cavity as well as the autonomous control of one’s own dental health. Therefore, oral hygiene instruction and the development of patient-centred preventive approaches should consider these factors.
... A significant association was found between high DFA and poor oral health-related quality of life (OHRQoL), a multidimensional measure evaluating oral health status and its related functional and psychosocial impacts [87], in children [88][89][90][91][92] as well as adults [93][94][95][96][97][98][99][100][101][102]. Significant relationships were also reported between high levels of DFA and measures of poor oral health (e.g., caries experience, gingival health, and toothbrushing frequency) in children [3,[5][6][7]17,50,51,53,[103][104][105][106][107][108][109][110][111][112][113][114][115][116][117][118][119][120][121][122] and adults [4,61,65,66,93,99,102,[123][124][125][126][127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142]. Nine pediatric studies [143][144][145][146][147][148][149][150][151] and three adult studies [56, 63,151,152] found no significant associations between DFA and poor oral health or OHRQoL measures. ...
... Catastrophizing refers to "an exaggerated negative orientation toward stressful or painful situations" [216] (p. 123) and has been associated with poor oral health in one study [88]. Interestingly, research has also reported relationships between catastrophizing and the other person factors reported here-SOR [217,218], general anxiety/fear [219], and DFA [38, 73,88,139,155,216,220]. ...
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Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.
... Dental anxiety is one of the major worries in repetitive dental practice, and it should be handled and managed in order to ensure appropriate oral healthcare [48], [49]. For this reason, the current study was carried out to assess dental anxiety and fear among undergraduate students at UST University in Yemen by utilizing DAS and DFS questionnaires. ...
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The aim was to investigate the dental anxiety and fear levels among students and its relation with their field of study and gender. This cross-sectional study included 720 (360 females and 360 males) which recruited from the collages of Dentistry and Humanities and Social Science in University of Science and Technology in Sana'a, Yemen. Corah's Dental Anxiety Scale (DAS) and Dental fear survey (DFS) was used to measure dental anxiety and fear among the study population. Spearman's correlation was used to analyze the association among the dental anxiety measurements or between DAS and DFS tests. Chi-square tests and linear regression analyses were used to determine the associations between dental anxiety or fear and contextual variables. Out of 720 students enrolled, 713 students (354 males and 359 females) completed and returned the questionnaire having response rate of 99.03%. The association between dental anxiety measurements or the DAS and DFS were statistically significant (p < 0.01). Dental students were less anxious and fear than humanities and social sciences students (p < 0.05). Females were more anxious and fear than males (p < 0.05). Dental anxiety and fear was more associated with female than other contextual variables [for fear (OR = 1.14, p = 0.001); for anxiety (OR = 1.90, p = 0.001)]. Dental anxiety was found to be related to dental fear. Male students were less anxious and fear than female students. Students from medical background faculties were less anxious and fear.
... [2] Good oral hygiene practices take only minutes a day and save more than $4 billion per year in treatment costs. [3] Loss of teeth adversely affects dietary intake and nutritional status of individuals and could be a distressing experience for many. [4,5] Tooth loss constitutes a final common pathway for most dental diseases and effects chewing ability, digestion, aesthetics, and as a result, their quality of life. ...
... [8][9][10] Additionally, highly anxious patients have poorer oral hygiene compared to nonanxious patients in general. 11 Eventually, dental anxiety may have a negative impact on social interactions and lead to a decline in quality of life, caused by embarrassment and feelings of shame or guilt when eating, smiling, and talking. 12 Historically, DA has been attributed to the expectation of pain, and the etiology of DA features classic characteristics of conditioning, originating in early periods of life (childhood to early adolescence). ...
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Objectives: The prevalence of "dental anxiety" (DA) is often underestimated and numerous diagnostic methods are available for dental practitioners. It is difficult to differentiate between a dental phobia requiring an interdisciplinary approach and DA, which can be managed by dental practitioners alone. The appropriate use of diagnostic tools is key for the successful management of highly anxious and/or phobic patients. The aim was to provide a guideline to recognize dental fear and to differentiate DA from patients who are highly anxious or even have a phobia. Data sources: In total, 8,929 articles that were selected for the development of the German guidelines for "Dental anxiety in adults" in PubMed, Web of Science, Embase, and MedPilot were filtered for diagnosis of DA disorder. The focus for this review was on the use of scales to measure DA levels. The methods and tools used in the 51 reviewed articles to assess DA levels were evaluated in terms of their practicability and suitability in daily practice to differentiate between phobia (ie, DA disorder) and nonpathologic anxiety. In addition, the internal consistency (Cronbach alpha) of the questionnaires/tools was determined. Conclusion: All identified DA questionnaires validated in the German language had an acceptable to excellent internal consistency (0.7 to 0.986). The only validated questionnaire-free method was galvanic skin reaction measurement. For the assessment of DA and diagnosis of a DA disorder in adults, the survey by means of any suitable questionnaire or even several questionnaires in combination with a behavioral observation of the patient is currently the method of choice. .
... The HBM theory also proposes that if an individual has su cient self-e cacy, perceived bene ts over barriers, and cues to action, he is more likely to perform a behavior [48]. Dental anxiety is a risk factor for caries in children [34] and individuals with poorer oral health practices are correlated with higher dental anxiety levels [53]. Our study results were consistent with previous studies and the HBM variables indicate that they are related to dental anxiety via OHB and caries status. ...
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Background: A vicious cycle exists between dental anxiety, oral health behaviors and oral health status. Based on previous research, psychological factors of the Health Belief Model (HBM) are associated with oral health behaviors and oral health, and are likely involved in this cycle. However, little is known about the relationship between HBM factors and dental anxiety of adolescents. The purpose of this cross-sectional study was to investigate the relationship between health belief factors, oral health and dental anxiety based on the constructs of the HBM. Methods: 1207 Grade 2 students from 12 secondary schools in Hong Kong were randomly selected and measured for the decayed, missing and filled permanent teeth (DMFT) index. Data for oral health behaviors, HBM constructs and dental anxiety were collected using questionnaires. The hierarchical entry of explanatory variables into logistic regression models estimating prevalence odds ratios (POR) were analyzed and 95% confidence intervals (95% CI) for DMFT and dental anxiety were generated. Path analysis was used to evaluate the appropriateness of the HBM as predictors for oral health behaviors, DMFT and dental anxiety. Results: Based on the full model analysis, individuals with higher perceived susceptibility of oral diseases (POR: 1.33, 95% CI: 1.14-1.56) or girls or whose mother received higher education level were likelier to have a DMFT≥1, while those with higher perceived severity (POR: 1.31, 95%CI: 1.09-1.57), flossing weekly, DMFT≥1 or higher general anxiety level statistically increases the possibility of dental anxiety. The results from path analysis indicated that stronger perceived susceptibility, greater severity of oral diseases, less performing of oral health behaviors and a higher score of DMFT were directly related to increased dental anxiety level. Other HBM variables, such as perceived susceptibility, self-efficacy beliefs, cues to action and perceived barriers, might influence dental anxiety through oral health behaviors and caries status. Conclusions: Clarifying the propositional structures of the HBM may help the future design of theory-based interventions in reducing dental anxiety and preventing dental caries.
... The HBM theory also proposes that if an individual has sufficient self-efficacy, perceived benefits over barriers, and cues to action, he is more likely to perform a behavior [23]. Dental anxiety is a risk factor for caries in children [33] and individuals with poorer oral health practices are correlated with higher dental anxiety levels [51]. Our study results were consistent with previous studies and the HBM variables indicate that they are related to dental anxiety via OHB and caries status. ...
Article
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Background A vicious cycle exists between dental anxiety, oral health behaviors and oral health status. Based on previous research, psychological factors of the Health Belief Model (HBM) are associated with oral health behaviors and oral health, and are likely involved in this cycle. However, little is known about the relationship between HBM factors and dental anxiety of adolescents. The purpose of this cross-sectional study was to investigate the relationship between health belief factors, oral health and dental anxiety based on the constructs of the HBM. Methods 1207 Grade 2 students from 12 secondary schools in Hong Kong were randomly selected and measured for the decayed, missing and filled permanent teeth (DMFT) index. Data for oral health behaviors, HBM constructs and dental anxiety were collected using questionnaires. The hierarchical entry of explanatory variables into logistic regression models estimating prevalence odds ratios (POR) were analyzed and 95% confidence intervals (95% CI) for DMFT and dental anxiety were generated. Path analysis was used to evaluate the appropriateness of the HBM as predictors for oral health behaviors, DMFT and dental anxiety. Results Based on the full model analysis, individuals with higher perceived susceptibility of oral diseases (POR: 1.33, 95% CI: 1.14–1.56) or girls or whose mother received higher education level were likelier to have a DMFT≥1, while those with higher perceived severity (POR: 1.31, 95%CI: 1.09–1.57), flossing weekly, DMFT≥1 or higher general anxiety level statistically increases the possibility of dental anxiety. The results from path analysis indicated that stronger perceived susceptibility, greater severity of oral diseases, less performing of oral health behaviors and a higher score of DMFT were directly related to increased dental anxiety level. Other HBM variables, such as perceived susceptibility, self-efficacy beliefs, cues to action and perceived barriers, might influence dental anxiety through oral health behaviors and caries status. Conclusions Clarifying the propositional structures of the HBM may help the future design of theory-based interventions in reducing dental anxiety and preventing dental caries.
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Objectives The aim of this study was to investigate the factors that influence the decayed, missing due to caries, and filled teeth (DMFT) index of patients with dental anxiety during dental treatment discontinuation.Materials and MethodsA total of 110 patients who complained of fear and anxiety toward dental treatments and who re-visited following treatment discontinuation were enrolled in the study. Patient and dental data considered to be related to caries were digitally collected from medical and dental records. The decayed (D), missing (M), and filled (F) scores, and the DMFT index before and after discontinuation were compared using Wilcoxon signed-rank tests, and the influential factors were evaluated using the Poisson and multiple regression analyses.ResultsThe D score and DMFT index increased significantly during the discontinuation period, and the F score decreased. There was no significant change in the M score. The change in the D score was influenced by the pre-discontinuation D score and the number of experiences of intravenous sedation, and the change in the F score was affected by the duration of treatment discontinuation, the DMFT index before discontinuation, and the number of experiences of intravenous sedation. The increase in the DMFT index was affected by the experience of intravenous sedation, the D and M scores, and the DMFT index before discontinuation.Conclusion Discontinuation of dental treatment was proven to increase the incidence of caries in patients with dental anxiety.Clinical Relevance: Avoiding treatment discontinuation is crucial, particularly in patients treated using intravenous sedation.
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Dental fear and anxiety are psychological reactions that interfere significantly with daily life. They are problems suffered by many patients worldwide that remain a significant challenge to providing adequate dental care. The multifactorial etiology of children’s dental fear and anxiety identifies the influence of many different risk factors in its development. The aim of this review article is to analyse the scientific literature regarding the different factors associated with dental fear and anxiety in children. Our review of the literature presents a critical analysis of the contributing factors in dental environment that have been investigated in the literature and provides an insight into the possible explanations on the influence of these factors in pediatric patients. Being familiar with these factors would facilitate behaviour management in anxious children. The findings of the literature review give grounds to undertake studies investigating the influence of contributing factors in all pediatric age subgroups.
Chapter
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In this study, socio-behavioral determinants of oral hygiene practices were examined across several dentate ethnic and age groups. Oral hygiene scale scores were constructed from toothbrushing and dental floss frequencies self-reported by population-based samples of middle-aged (35-44 years) and older (65-74 years) dentate adults representing Baltimore African-American and White, San Antonio Hispanic and non-Hispanic White, and Navajo and Lakota Native American persons participating in the WHO International Collaborative Study of Oral Health Outcomes (ICS-II) survey. Female gender, education, certain oral health beliefs, household income, and the presence of a usual source of care were revealed with multivariate analysis to show a significant positive relationship with higher oral hygiene scale scores (indicating better personal oral hygiene practices). Other socio-behavioral variables exhibited a more varied, ethnic-specific pattern of association with oral hygiene scale scores.
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The present paper examines the implications of recent developments in classical conditioning for consumer research. It discusses the finding that the conditioned response need not resemble the unconditioned response, and that the conditioned stimulus must predict but not necessarily precede the unconditioned stimulus for conditioning to occur. The paper also considers the implications of several situations in which classical conditioning may unexpectedly fail to occur, several of the characteristics of classically conditioned behavior, and the role of awareness in conditioning.
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The measurement of dental fear is important due to its high prevalence and appreciable individual, clinical, and public health consequences. However, existing measures of dental anxiety and fear (DAF) have theoretical or practical limitations. This study describes the development and subsequent assessment of the reliability and validity of test scores of a new DAF scale for adults. The Index of Dental Anxiety and Fear (IDAF-4C+) contains 3 modules that measure DAF, dental phobia, and feared dental stimuli. The final 8-item DAF module (IDAF-4C) assesses emotional, behavioral, physiological, and cognitive components of the anxiety and fear response. The proposed scale dimensionality received support from exploratory factor analysis. IDAF-4C items showed good internal consistency (Cronbach's alpha = .94) and test-retest reliability at 4 months (r = .82), and the scale was strongly associated with other dental fear scales as well as with dental visiting patterns, avoidance of the dentist, and dental phobia diagnosis. The convergent and predictive validity of the IDAF-4C compared positively to Corah's (1969; Corah, Gale, & Illig, 1978) Dental Anxiety Scale and a single-item measure of dental fear, and the scale predicted future dental visiting and visit perceptions. Both phobia and stimulus modules showed strong and statistically significant associations with DAF ratings. In all, sufficient evidence is provided to demonstrate that the new scale would be a useful tool to assess DAF in an adult population. The IDAF-4C+ is based on strong theoretical underpinnings, yet the scale is practical enough for application across a variety of potential uses.
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This study aimed to investigate the association between dental fear and both dental caries and periodontal indicators. A three-stage stratified clustered sample of the Australian adult population completed a computer-assisted telephone interview followed by a clinical examination. Oral health measures were the DMFT index and its components, periodontitis and gingivitis. A total of 5364 adults aged 18-91 years were dentally examined. Higher dental fear was significantly associated with more decayed teeth (DT), missing teeth (MT) and DMFT. There was an inverted 'U' association between dental fear and the number of filled teeth (FT). Periodontitis and gingivitis were not associated with dental fear. The association between dental fear and DMFT was significant for adults aged 18-29 and 30-44 years, but not in older ages. Dental fear was significantly associated with more DT, MT, and DMFT but with fewer FT after controlling for age, sex, income, employment status, tertiary education, dental insurance status and oral hygiene. This study helps reconcile some of the conflicting results of previous studies and establishes that dental fear is associated with more decayed and missing teeth but fewer FT. That people with higher dental fear have significantly more caries experience underlines the importance of identifying and then reducing dental fear as important steps in improving adult oral health.
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This study examined the relationship between multidimensional competitive state anxiety and cognitive (i.e. digit span) and motor (i.e. perceptuo-motor speed) subcomponents of performance in an experimental group of hockey players during the period leading up to an important hockey match, and also in a control group of hockey players before a routine training session. Using a 'time-to-event' experimental paradigm, an increase in somatic anxiety 20 min before the hockey match was accompanied by improved perceptuo-motor speed performance. Stepwise multiple regression analyses showed that somatic anxiety was negatively related to digit span performance, whilst somatic anxiety and self-confidence were positively related to perceptuo-motor speed performance. These findings suggest that somatic anxiety may be an important source of performance variance.
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Although negative dental experiences are often cited as the major factor in the development of dental anxiety, very few studies have provided data on their prevalence. The studies that are available used limited samples from which it is not possible to generalise, or confined their enquiries to painful experiences only. In this paper data are provided on negative dental experiences and their relationship to dental anxiety obtained from a large, random sample of the general population. Just over three-quarters reported what are termed as direct negative experiences; 71 per cent had had experiences that were painful, 23 per cent experiences that were frightening and 9 per cent experiences that were embarrassing. Such experiences were not confined to childhood. For 23 per cent, the first experience of this kind happened during adolescence and for 40 per cent in adulthood. The relationship between these experiences and dental anxiety was strong. Subjects reporting all three types of experience were 22.4 times at risk of being dentally anxious than subjects reporting none of them. The data suggested that the nature of these unpleasant experiences was more important than the age at which they occurred in predicting dental anxiety. One third of dentally anxious subjects reported a negative response experience in the form of feeling faint, fainting or having a panic attack while at the dentist. Further research using more appropriate methods is needed to clarify the role of dental experiences in the genesis of dental anxiety.
Article
This cross-cultural study investigated adult dental fear patients in three countries. A joint intake interview questionnaire and a dental anxiety scale explored the level, background and concomitant factors of dental anxiety among patients at the Universities of Tel Aviv (Israel), Goteborg (Sweden), and Pittsburgh (USA). It was shown that patients at all three sites were quite similar with regard to age, sex, level of dental anxiety (DAS) and avoidance time. Negative emotions were common, with more negative everyday life effects among Swedish patients. Regardless of country, most patients stated that they had always been fearful, but environmental etiologic factors were frequently reported. Swedish patients more often reported both direct and indirect learning patterns than Israeli patients. Patients' motivation for treatment was high, while the belief in getting fear reduction was clearly lower. The most common reason for Israeli patients to seek treatment was a personal decision to try to cope with the situation, while for Swedish patients it was pain. Israeli and US patients preferred more 'active' modes of treatment such as behavioral management therapies, while Swedish patients equally preferred active and more 'passive' treatment approaches such as general anesthesia. Preference for dentist attributes were similar among groups and underlined the strong emphasis that fearful individuals place upon dentists' behaviors and their performance of dentistry.