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ISSN: 2348 - 2915
Volume 8 / Issue 2 / April-June 2021
Official Publication of Dr. D.Y. Patil Vidyapeeth, Pune
Dr. D.Y. Patil Dental College and Hospital, Pimpri, Pune
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Journal of Dental Research and Review • Volume 8 • Issue 2 • April-June 2021 • Pages ***-***
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Introduction
Dental problems are always acted as a
burden on the people. They are often
accompanied by pain, decreased social
functioning, disturbance in daily routine,
etc.[1] There is an increase in the prevalence
of dental diseases and one of the reasons
is dental anxiety. Dental anxiety is a
condition involving worry about dental
treatment leading to the feeling of losing
control.[2] It is excessive or unreasonable
anxiety toward dental procedures and
treatment leading to a negative impact on
one’s daily life as well as avoidance of
dental treatment.[3] Researchers identied
few behavioral symptoms in dental anxiety
patients such as dgeting, sitting on the
edge of the chair, startled reaction to noise,
and generalized muscle tensions.[4]
Dental anxiety is the major concern for
dental care professionals and is ranked
fourth among common fears.[5,6] Research
Address for correspondence:
Dr. Kriti Vyas,
Department of Psychology,
Faculty of Humanities and
Social Sciences, Vishwakarma
University, Pune, Maharashtra,
India.
E-mail: kritivyas8288@gmail.
com
Access this article online
Website: www.jdrr.org
DOI: 10.4103/jdrr.jdrr_142_20
Quick Response Code:
Abstract
Introduction: Dental anxiety is a state of uneasiness and worry, making the patient feels that
something terrible will happen to him regarding dental treatment and procedure. Research suggests
that dental anxiety is a prominent factor in leading to avoidance of dental treatment by the patients.
The intensity of dental anxiety varies individually and across gender. Research suggests that adopting
healthy dental care habits encourages good oral health, contributing to the quality of life, whereas
poor dental habits can lead to dental problems. Therefore, the present study attempts to explore the
level of dental anxiety and dental care habits across age groups and gender. Methods: The sample
consists of 150 patients from Delhi/National Capital Region. They were divided into three age
groups – adolescence (n = 50), young adulthood (n = 50), and middle adulthood (n = 50). Modied
Dental Anxiety Scale was used to assess dental anxiety and a semi‑structured interview was taken
to assess the level of dental hygiene among the patients. Results: there are statistically signicant
differences in dental anxiety scores between males and females. Our results also point that these
gender differences persist across age groups – adolescence, young adulthood, and middle adulthood
on dental anxiety. Conclusion: The ndings reveal higher dental anxiety levels among adolescents,
which gradually increase with age. Furthermore, females are more susceptible to have dental anxiety
than males. Thus, dental professionals should provide age and gender‑targeted counseling to avoid
dental anxiety among their patients.
Keywords: Adolescence, dental anxiety, dental hygiene, middle adulthood, young adulthood
Exploring Dental Anxiety among Male and Female across Adolescents,
Young Adults, and Middle Adults
Original Article
Samina Bano,
Syed Ansar
Ahmad1,
Kriti Vyas2
Department of Psychology,
Jamia Millia Islamia,
1Department of Oral and
Maxillofacial Surgery,
Faculty of Dentistry, Jamia
Millia Islamia, New Delhi,
2Department of Psychology,
Faculty of Humanities and
Social Sciences, Vishwakarma
University, Pune, Maharashtra,
India
How to cite this article: Bano S, Ahmad SA, Vyas K.
Exploring dental anxiety among male and female
across adolescents, young adults, and middle adults.
J Dent Res Rev 2021;8:107-12.
This is an open access journal, and arcles are
distributed under the terms of the Creave Commons
Aribuon‑NonCommercial‑ShareAlike 4.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially,
as long as appropriate credit is given and the new creaons are
licensed under the idencal terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
suggests that only a few dental patients
do not experience anxiety.[7] Dental
anxiety was also found high among dental
patients in India.[8] Studies suggest that
dental anxiety can vary according to the
age group. Dental anxiety increases from
11% to 13% in adolescence to 26% during
young adulthood.[9]
Studies show different reasons for this
dental anxiety. One of the reasons is the
clinical setup; for example, patients feel
powerless while sitting on the patient
chair in the reclined position and dentist
checking the patients’ mouth cavity and
using drillers.[10,11] Another reason for
dental anxiety is the dental treatment
and procedures such as use of injections,
scrapping, and the sight of blood.[12]
Patients with dental anxiety problems
tend to avoid dental treatment and further
aggravate the dental problem leading to
poor oral health.[3,13] Research suggests
that it leads to a vicious cycle of dental
fear or anxiety because avoidance leads to
delay in treatment, this further deteriorates
Submitted: 10‑Oct‑2020
Accepted: 22‑Feb‑2021
Published: 16‑Jul‑2021
Bano, et al.: Gender dierences in dental anxiety across age groups
108 Journal of Dental Research and Review | Volume 8 | Issue 2 | April-June 2021
dental problem; as a result, the patients need to undergo
specialized and complex treatment procedures. These
treatments cause them pain thereby reinforcing their dental
anxiety or fear.[14] Therefore, dental professionals must deal
with and ease the dental anxiety of the patients.
Another concern for dental health professionals is
maintaining good dental hygiene by the patients. It has
been established that following regular and proper dental
care habits such as brushing at least twice a day, regular use
of dental oss and mouthwash, and using uoride‑based
toothpaste help in reducing the occurrence of dental caries
and other dental problems.[15,16]
Apart from the aforementioned reasons, dental anxiety is
also affected by a number of factors like age and gender
of the patients. Regarding age, some studies suggest that
dental anxiety starts in childhood and is at the peak in
early adulthood and slowly tapers down with increasing
age.[17] In contrast, some studies have indicated that it
originates in adolescents and young adulthood or maybe
later life.[18] A study conducted by a group of researchers
provides evidence that dental anxiety was high among the
age groups of 25–35 and 35–45 years and low for the age
group of 55–65 years.[8] On the contrary, another study
found that the age group between 20 and 39 years was
high on dental anxiety as compared to the younger and
older population.[19] Due to such mixed results, the present
study explores the level of dental anxiety across three age
groups – adolescents, young adults, and middle adults.
In addition to age, previous literatures have also suggested
that dental anxiety varies according to gender, particularly
females are prone to high dental anxiety as compared to
males.[8,20,21] However, again few recent studies found no
signicant gender difference on dental anxiety.[22,23]
To summarize, previous studies investigating dental anxiety
across different age groups have shown an inconsistent
nding. Studies have looked at dental anxiety either across
gender or age, and their conclusion is focused either on
age difference or gender difference. None of the studies
so far have explored the age‑related changes in dental
anxiety with respect to gender. However, how dental
anxiety changes among males and females as the age
progresses is still an open question. Therefore, the present
study investigates whether dental anxiety varies across the
different age groups with respect to gender.
Methods
Participants
Dental patients were selected from Dental Hospital at Jamia
Millia Islamia University, Delhi. One hundred and sixty‑ve
patients were approached, those who gave the consent were
included in the nal sample. Few of the participants were
dropped from the sample due to incomplete information.
Hence, the nal sample comprised 150 dental patients. The
sample was divided into three age groups – adolescence
(12–19 years), young adulthood (20–40 years), and
middle adulthood (41–60 years). Each group consists of
50 patients.
Materials
Demographic prole
The patients were asked to ll up a brief sociodemographic
prole about their age, gender, religion, education
qualication, profession, family type, family annual
income, housing type, and housing space [Table 1].
Dental history and hygiene
The patients were asked to ll up details, such as frequency
of brushing and tongue cleaning, methods of maintaining
oral health, complaints of tooth sensitivity and gums’
bleeding, reasons for a dental visit, and treatment sought
by them.
Dental anxiety
Modied Dental Anxiety Scale (MDAS) developed by
Humphris, Morrison, and Lindsay (1995)[24] was used to
measure dental anxiety. The scale was originally based on
the Corah’s Dental Anxiety Scale. The scale consists of
5 items and patients need to rate their responses from not
anxious (1) to extremely anxious (5). The total score ranges
from 5 to 25. A cutoff score of 19 and above denotes high
Table 1: Sociodemographic prole of the participants
Demographics Percentage
Gender
Male 43.3
Female 56.7
Religion
Hindu 34
Muslims 63.3
Sikhs 0.7
Christian 2
Family annual income
Low 49.3
Middle low 29.3
Middle high 19.3
High 2
Family type
Joint 47.3
Nuclear 52.7
Housing ownership
Self‑owned 57.3
Paid (Government) 6.7
Rented 36
Housing space
LIG 20.7
MIG 54
HIG 25.3
LIG: Low income group, MIG: Middle income group, HIG: High
income group
Bano, et al.: Gender dierences in dental anxiety across age groups
109Journal of Dental Research and Review | Volume 8 | Issue 2 | April-June 2021
dental anxiety or dental phobic. The Cronbach’s alpha
value of the Dental Anxiety Scale for the present study
was 86.
Ethical approval
The protocol involved in the present study was approved
by the Institutional Ethics Committee for the Faculty of
Social Sciences, Jamia Millia Islamia, New Delhi.
Procedure
The Dental Hospital at Jamia Millia Islamia was contacted
and permission was obtained from the authorities. The
patients sitting in the waiting area of the out‑patient
department were approached. The patients were briefed
about the study. They were assured about the condentiality
and anonymity of the information. After obtaining
verbal consent from them, they were asked to ll up the
demographic prole and gave details about the dental
history and dental care habits. After that, they were asked
to ll the MDAS to assess dental anxiety among patients.
The patients were thanked for contributing to the research.
Statistical analysis
After the data collection, a statistical analysis was
performed using JASP‑0.12.2 software. To examine the
differences in terms of age and gender on dental anxiety,
we employed a two‑way analysis of variance (ANOVA)
along with the simple main effect analysis.
Results
Participants’ responses were recorded and summarized in
terms of mean and standard deviation across the age group
and gender [Table 2].
To investigate whether the dental anxiety scores differ
across age and gender, we employed 2 (gender: male and
female) ×3 (age: adolescents, young, and middle adults)
ANOVA. The ANOVA results suggest that the dental anxiety
scores were signicantly different across three different age
groups (F (2, 144) =10.31, P = 0.001 partial η2 = 0.11).
Similarly, the results also indicate that the dental anxiety
scores for males and females were also signicantly
different (F (1, 144) =27.07, P = 0.001, partial η2 = 0.14).
However, age × gender interaction term was not
statistically signicant (F (2, 144) =1.26, P = 0.28, partial
η2 = 0.01) [Table 3].
Since the main effect of age and gender was found
signicant, we motivated to do the simple main effect
to test whether the dental anxiety scores differ for
males and females across three age groups. Therefore,
we conducted the simple main effect analysis, and
the results suggest that the dental anxiety scores
were signicantly different for male and female in
adolescents (F (1, 144) = 8.623, P = 0.004) and young
adults (F (1, 144) =17.343, P = 0.001). However, the male
and female dental anxiety scores in the middle adult group
were partially signicant (F (1, 144) =3.730, P = 0.055).
The overall analysis revealed that dental anxiety differs
across different age groups. The adolescents experience
the highest dental anxiety (13.52 ± 4.73), and middle
adults (8.94 ± 4.69) experience the lowest dental anxiety.
Similarly, the results also indicate that females (13.32 ± 5.21)
exhibited more dental anxiety than males (9.12 ± 3.6).
Discussion
In the present study, we investigated the effect of age and
gender on the dental anxiety. The results of the present
study are in line with the previous literature suggesting that
dental anxiety decreases with the age.[16,25‑28] Our ndings
are also in line with the previous study suggesting a similar
pattern for general anxiety. For example, it has been noted
that general anxiety decreases with increasing age, exposure
to diseases, and medications.[29] A few older patients of the
present study also reported that they are already suffering
from several other diseases such as thyroid, knee pain, skin
diseases, and taking medical treatments. The exposure to
continuous medical treatment makes them more habituated
and enhanced their ability to cope up with medical
treatments.[29,30]
Table 3: Analysis of variance result table showing the
main effects of age, gender, and age×gender interaction
Variable Sum of
squares
df Mean
square
F P η² P
Age 384.935 2 192.468 10.311 <0.001 0.125
Gender 505.444 1 505.444 27.079 <0.001 0.158
Age×gender 47.170 2 23.585 1.264 0.286 0.017
Residuals 2687.832 144 18.666 ‑ ‑ ‑
Table 2: The mean and standard deviation for males and females across the three different age groups
Age Gender Mean SD N
Adolescents Female 14.639 4.734 36
Male 10.643 3.455 14
Middle Adults Female 10.120 4.944 25
Male 7.760 4.196 25
Young Adults Female 14.708 4.894 24
Male 9.615 2.743 26
SD: Standard deviation
Bano, et al.: Gender dierences in dental anxiety across age groups
110 Journal of Dental Research and Review | Volume 8 | Issue 2 | April-June 2021
Further, the item‑wise inspection suggests that among all
the items, adolescents were more extremely anxious from
the use of local anesthetic injection and tooth drilling
during the dental procedures. This is also consistent with
previous studies.[31,32] The potential explanation for such
behavior could be that adolescents or younger population
have relatively less exposure to these dental equipment as
compared to older adults.[29] This leads to the development
of “fear of unknown.” It has been argued that because of
the feeling of such unknown fear, adolescents are more
prone to anxiety toward the various dental procedures.[2]
In regard to gender, current ndings are in line with the
previous studies, wherein females showed a higher level of
dental anxiety as compared to males across the three age
groups.[21,33‑36] This can be due to gender roles which makes
female more acceptable of their anxiety and low tolerance
toward pain. For males, it might be difcult to accept
their anxiety about the conventional gender roles.[37,38]
Researchers have suggested the differential pain tolerance
ability among males and females. For example, females
were more likely to exhibit low pain tolerance compared
to males.[29,39,40] At the same time, it was also observed
that women tend to remember their painful experience
more vividly even after the treatment is over.[41] These
fundamental differences in tolerance level could also be
another reason for the gender difference.
Further, it has also been suggested that maintaining dental
hygiene is very important for optimal oral health and
prevention of dental problems. Our data related to dental
hygiene indicate that majority of patients were only using
toothpaste and brush (87.3%) and only 1.3% of people
used dental oss as the methods to maintain the dental
hygiene. Ten percent of patients used mouthwash as well as
toothpaste. This shows that there is a need of improvement
in the methods used for implementing dental hygiene habits.
It has been found that patients need to use dental oss and
mouthwash rather than just toothpaste and brush. Research
suggests that toothbrushing alone cannot take out the plaque
formation from teeth; therefore, the use of mouthwash
and oss is important.[42] If plaque is not removed, then it
could affect the gums leading to gum bleedings[43] and this
problem is present in 42% of patients in the present study.
It was also found that 40% of the patients are brushing once
in a day and 20% of patients never clean their tongue. The
research found that if the tongue is not properly cleaned,
then bacteria can be produced in the mouth leading to
various problems like bad smell and oral diseases.[44] It could
also be seen that very few dental patients visited the dentist
for a regular checkup (14.7%) and they visited mainly
when there was tooth pain (80.7%). This is again pointing
toward negligence by patients toward maintaining dental
hygiene. They only get attentive to their oral health when
there is unbearable pain. It is recommended by the dental
professionals that regular dental health checkup is important
for avoiding the dental caries and other diseases.[45]
Limitations and future scope
The present study has a few limitations and implications
for future research. First, the data collection was based on
the opportunity sampling technique; hence, the possibility
of sample selection bias could be there. Only one dental
hospital in Delhi (Jamia Millia Islamia) was approached
for the same, so ndings could not be generalized. To
avoid such bias, further research needs to be conducted in
different parts of the country on the larger sample. Second,
the current study only used quantitative data to explore
the differences in the level of anxiety among different
age groups and gender. However, the study did not use
qualitative data to explore in‑depth causes for dental anxiety
and factors contributing to it. Hence, future researches can
focus on using qualitative (i.e., interview) methods to gain
more in‑depth understanding of dental anxiety. Third, due to
methodological limitations, the present study fails to explore
any relationship between dental care habits and dental
anxiety. Researchers can further explore more about dental
care habits and then nding the relation between the uses of
healthy or unhealthy dental habits with dental anxiety.
Conclusion
Oral health is an essential part of our life. However, it
seemed to be neglected by many people. Therefore, it is
essential for dental professionals to spread awareness about
dental treatment and procedures as well as dental hygiene
habits such as regular brushing, use of mouthwash and
ossing, and regular dental checkups. Dental professionals
can also set up free dental service camps so that people
can get access to dental services and be aware. Increased
awareness about dental procedures will help in relieving
the patients’ anxiety. It is imperative to identify patients’
dental anxiety before starting the treatment. This will be
helpful in generating awareness of dental hygiene with
regular appointments, which further can reduce the level
of anxiety among those patients. It is imperative for dental
professionals to be sensitive and empathetic to patients’
anxiety. As the results suggested that dental anxiety is
more among adolescents, this means school and college
authorities can play an important role in promoting
awareness and the importance of dental hygiene. Further,
in regard to gender, female patients can be counseled
before any dental treatment and made aware of whole
dental procedures. As per the ndings, male dental patients
might not be expressing their anxieties due to gender roles.
Hence, dental care providers can provide the space to
these patients so that they can freely share their feelings
and thoughts. These steps will be helpful to improve
patient–doctor relationship and patients’ well‑being.
Ethical clearance
The study was approved by the Institutional Ethical
Committee for Social Sciences, Jamia Millia Islamia, New
Delhi. An ethical clearance letter was issued on 07/01/2020.
Bano, et al.: Gender dierences in dental anxiety across age groups
111Journal of Dental Research and Review | Volume 8 | Issue 2 | April-June 2021
Acknowledgment
The authors acknowledge Faculty of Dentistry, Jamia
Millia Islamia, New Delhi, for the dental hospital and
dental patients who have volunteered themselves for this
study.
Financial support and sponsorship
Self.
Conicts of interest
There are no conicts of interest.
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