Fear of dentistry

Prediction of behavior management problems in children

The aim of the present investigation was to study non-dental and dental background variables with a view to estimating their influence on behavior management problems by means of a structured interview and analyzing their separate and combined predictive power. The material consisted of a case group, 101 children aged 3-16 yr, referred for management problems to clinics of specialized pedodontics, and a control group, individually matched with the cases as regards age, sex, residential area, number of tooth surfaces restored, and dentist. The children or their parents were interviewed concerning background variables. Logistic regression was used for the analyses. Three non-dental variables turned out to be statistically significant as predictors (P less than 0.05): problems on visiting a medical doctor, dental fear in the mother or father, and anxiety when meeting unfamiliar people. Management problems might be expected if one of these attributes is found. Four dental variables had significant predictive power: earlier problems on seeing a dentist, dislike of the dentist, not enough time to adjust to the dental situation, and fear of injection. However, none of these dental variables was found to have predictive power in 3-6-yr-olds, and none of them improved the predictive power of the three main non-dental variables.

Electrodermal activity, dental anxiety, and fear of dentistry in a group of parenteral drug addicts

The present study was undertaken in order to evaluate whether electrodermal activity was a useful tool with which to measure dental anxiety in a group of drug addicts. Electrodermal activity was compared to the subjects' self-reported feelings during ordinary dental treatment sessions. In the first part of the study the level of electrodermal activity during treatment sessions was videotaped and recorded on paper by means of a polygraph. The patients were interviewed using a semi-structured questionnaire dealing with the addicts' dental anxiety and fear. In connection with the interviews the addicts completed Corah's Dental Anxiety Scale (CDAS). There was no recognizable pattern in electrodermal activity when this was compared with the patients' feelings during the treatments. Median CDAS was 9.5. In the second part of the study, electrodermal activity was recorded on the polygraph only. This group also completed a CDAS questionnaire. No correlation between the patients' self-reported highest level of anxiety and level of electrodermal activity, number of fluctuations or amplitude in relation to specific dental stimuli was found; agreement was found in two, three and none of 10 cases respectively. Median CDAS was 10.0. It could be concluded that, although the study revealed apprehension and situational anxiety among the addicts, no correlation to electrodermal activity was found. This discrepancy between the physiological and cognitive data probably reflects the uncertainty of these measures under the given circumstances.

Psychologic correlates of dental anxiety

In an attempt to establish the relationships between dental anxiety and personality traits, such as neuroticism and locus of control, a survey has been carried out among 30-40-yr-olds in a Dutch town. In the first instance, the questionnaires comprising the psychologic items were treated by Non-Metric Principal Components analysis to detect the underlying structure. The principal components found were then used in a second-stage analysis. The results appear to be at variance with the literature, i.e. subgroups discernible in the sample by sets of psychologic features were not associated with dental anxiety categories.

Sociodemographic correlates of dental anxiety

In a survey comprising 620 30-40-yr-old inhabitants of a Dutch town, dental anxiety was measured along with some sociodemographic variables. The data were analyzed in an attempt to reveal associations between sociodemographically determined groups of respondents and their scores on the different measurements of dental anxiety. Women reported higher dental anxiety levels than men, with the exception of body damage anticipation anxiety. The rank order of birth seemed to have no influence. Divorced men and women reported a higher anxiety level on two of the anxiety measurements, but the association appeared to be weak. A lower level of education, irregular dental attendance, and edentulousness appeared to be associated with a higher level of dental anxiety.

Usefulness of two psychometric scales in Swedish patients with severe dental fear

Dental fears and other fears were assessed in 67 patients with dental fear with the Corah Dental Anxiety Scale (CDAS), the Geer Fear Scale (GFS), and a behavioral dentist's rating scale (DR). Patients were selected because of extreme initial dental fear (n = 20), favorable response to treatment for dental fear (n = 23). CDAS change paralleled behavioral change (DR), supporting the usefulness of CDAS in assessing dental fear. GFS scores did not change in either group but were higher among patients who did not respond to treatment for dental fear; these findings are discussed in terms of treatment outcome prediction and treatment specificity.

Prevalence of dentistry phobia and its relation to missing teeth, alveolar bone loss and dental care habits in an urban community sample

In a representative sample of 784 women in Gothenburg, aged 38-54 years, the point prevalence of dentistry phobia was 13.4%; 4.3% suffered a dentistry phobia of high degree. The prevalence was much increased in women with low school education and in the lower social classes. In most cases (88%) the phobia onset occurred before age 20. Only 11% of the phobic subjects were aware of having been exposed to anxiety-provoking dental treatment situations at onset of phobia. All phobics reported a chronic course, although most of them (90%) had partial remissions at times. Phobia of dental treatment was related to high number of missing teeth, high amount of alveolar bone loss and a high prevalence of removable dentures. Most associations between dentistry phobia and impaired dental status remained statistically significant when allowance was made for age and social class. The neglected dental status in the phobic women may have psychological effects and impair the social functioning. As the incidence peak occurs early in life, preventive measures must primarily be directed against children and adolescents.

Psychometric measures of dental fear

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

Dental fear and avoidance: causes, symptoms, and consequences

A specialized community dental unit for dental fear treatment was used to investigate 160 adult patients. The patients, predominantly women 20 to 40 years old, had avoided regular dental care for an average of 16 years. Psychosocial and psychosomatic conditions were common. Dental fear generally had started in childhood (85%) and the dominating causative factor was previous traumatic dental experiences. For fear of early origin, the dentist's professional behavior was most important, whereas for fear acquired in adult years, pain was important. The most feared events in dentistry ranked by the patients were drilling, having an anesthetic, and extraction. The most desired dentist attributes were understanding and trying to avoid pain, whereas the most undesired were being heavy-handed, critical, and remote and distant. The dental status was strongly affected by fear and avoidance, and the deterioration was significantly more pronounced in men.

Psychological management of anxiety and pain during dental treatment

Sensation information, perceived control and distraction were compared with routine dentistry in a study of the effect of psychological context on pain and anxiety during dental treatment. The results indicated that the provision of sensation information was the most effective treatment.