Assessment of a dental anxiety scale

Acquisition and maintenance of dental anxiety: the role of conditioning experiences and cognitive factors

This study presents a contribution to the understanding of the mechanisms that are involved in the development and maintenance of dental anxiety. Subjects were 224 undergraduate psychology students who completed questionnaires regarding dental anxiety, painful and traumatic experiences, negative cognitions, dental beliefs, and how their attitude to dental treatment had changed during their life. The results showed that both the extent to which earlier dental treatments were perceived as painful and the extent to which these incidents were reported as traumatic were significantly related to dental anxiety. Evidence was also found to support the latent inhibition hypothesis, which predicts that patients less easily acquire dental anxiety in case they received a number of relatively painless treatments prior to conditioning. Both findings confirmed those earlier obtained by Davey in a conceptually similar design (Behaviour Research and Therapy, 27, 51-58, 1989). In addition, frequency of negative cognitions about dental treatment and dental anxiety appeared to be positively related (r = 0.74; P < 0.001). Significant differences were found between highly anxious Ss and Ss showing low levels of anxiety on a variety of expectations and beliefs related to undergoing dental treatment. The results are discussed in terms of a cognitive-behavioural perspective of dental anxiety.

Disproportionate dental anxiety in the over 50s

Explanations of dental anxiety in terms of either conditioning or personality predispositions alone are not sufficient to account for all individuals presenting with dental anxiety, since they are not a homogenous group. It was hypothesized that individuals, with wide ranging anxiety problems would be more likely to carry dental anxiety into old age. This prediction was supported by a comparison of older dentally anxious individuals with other older individuals who admitted to dental anxiety previously but were no longer dentally anxious. The results were interpreted in terms of Lang's bioinformation model of anxiety.

Skin conductance, Marlowe-Crowne defensiveness, and dental anxiety

The present study assesses the relationship between self-reported dental anxiety (Dental Anxiety Inventory, Dental Anxiety Scale, and Duration of Psychophysiological Fear Reactions), electrodermal activity (skin-conductance level and frequency of spontaneous responses), and Marlowe-Crowne defensiveness. All measurements were made twice. The first session was scheduled immediately before a semi-annual dental check-up (stress condition), and baseline measurements were made two months later without the prospect of a dental appointment. Subjects were male dental patients who regularly attended a university dental clinic and a clinic for Special Dental Care. The main findings were that the low anxious-high defensive-scoring (Marlowe-Crowne Denial subscale) university patients showed significantly higher skin-conductance levels and frequency of nonspecific fluctuations than the low anxious-low defensive-scoring subjects. Besides, the conductance values of the low anxious-high defensive-scoring subjects resembled those of the high anxious-low defensive-scoring patients of the clinic for Special Dental Care, the baseline frequency of nonspecific fluctuations excepted.

Long-term follow-up of treated dental phobics

Behavioural treatment programmes have been shown repeatedly to be effective in alleviating dental anxiety but few studies have provided long-term follow-ups. In this study, dentally anxious Ss who had completed a 4-session behavioural group programme were followed up for periods between 1 and 4 years after successful completion of treatment. It was hypothesized that dental visit satisfaction would be associated with regular dental attendance. 88% of Ss contacted agreed to cooperate; of these, 70% were still maintaining regular check-ups. There were no differences between regular and irregular attenders in terms of age, gender, education, marital status, degree of pre-treatment avoidance or time elapsed since completion of the programme. However, Ss who did not see their dentists regularly were more likely to have shown higher levels of anxiety immediately after completing the programme, less concordance between the subjective and overt behavioural aspects of anxiety and to have experienced more invasive than non-invasive procedures than the others. It was argued that dentally anxious individuals are not a homogeneous group and that a better understanding of their individual differences would lead to the development of more efficacious treatment procedures.

Dental anxiety of parents in an Israeli kibbutz population

The purpose of the present study was to compare the levels of dental anxiety in both parents of children in a kibbutz in Israel. Sixty pairs of parents between 22 and 56 years of age with children aged 1-14 years comprised the study population. The parents were divided into three age groups: 22-34 years, 35-44 years, and 45-56 years. Dental anxiety was assessed by using Corah's Dental Anxiety Scale and Kleinknecht's Dental Fear Survey. The mothers showed significantly higher levels of dental anxiety than the fathers. Within the families dental anxiety of husbands and wives were poorly correlated. Mothers in the 35-44-year age group displayed the highest scores of dental anxiety. Among the fathers, dental anxiety was highest in the youngest age group (22-34 years). The mean Corah score for the combined group was much higher than those reported for patients in private clinics in Sweden and in the USA. The results suggest that mothers in their mid-thirties to mid-forties merit special support with regard to the dental situation.

The anxiolytic effects of intravenous sedation using midazolam alone or in multiple drug techniques

This study examines four drug combinations (midazolam, midazolam-midazolam, fentanyl-midazolam, and fentanyl-midazolam-methohexital) in a placebo-controlled double-blind clinical trial of intravenous sedation. It tests the hypothesis that there is no difference between the anxiolytic effect of the four combinations when compared with a saline placebo. Subjects were 207 mildly anxious young adults having their third molars removed. Cognitive measures of anxiety increased from preoperative levels in the placebo and both midazolam groups (P < .05). The anxiety response remained the same in the fentanyl-midazolam and fentanyl-midazolam-methohexital groups (P > .05). The level of successful anxiolysis ranged from 24% in the placebo group to 74% in the barbiturate group. Using the log likelihood method, comparisons suggest that the drug groups (from midazolam alone to the methohexital combination) have increasingly positive anxiolytic effects even when controlling for the effects of dental fear and intraoperative pain. The fentanyl-midazolam group is 8.1 and the methohexital group is 9.0 times more likely to have had a favorable outcome than the placebo group. Additional analyses of behavioral measures of anxiety yielded parallel results. Global evaluations after surgery were related to the success of anxiolysis for subjects in the active drug conditions (P < .05).

Patient-controlled analgesia: a comparison of dosing regimens for acute postsurgical pain

This study compares several dosing regimens for patient-controlled analgesia (PCA) in the management of acute maxillofacial surgical pain. The dosing methods differed by presence or absence of an active drug (morphine [MS] vs saline), presence of a baseline infusion, and dose of drug delivered. Sixty-eight patients were enrolled in this prospective, randomized, double-blind, placebo-controlled trial that lasted 24 hours. The study was completed in two separate parts, each of which involved randomization of patients into four groups (part I) or three groups (part II). No significant differences were noted in pain scores in the preoperative, immediate postoperative, or 4-, 8-, 12-, or 24-hour periods among any of the groups, including the saline-only control groups; in either part I or part II of the study. Significant differences (P < .01), however, were noted in nausea and vomiting scores. Fifty percent (50%) of patients receiving MS vomited, while no patients in the saline groups vomited. This study calls into question the usefulness of PCA with MS in maxillofacial surgery patients. Pain control was questionable at best, and the rate of emesis was unacceptably high in patients with potentially compromised airways. Further research is required to determine if other analgesics provide better pain control with less nausea in the PCA system or if antiemetics can effectively be used to lower the incidence of nausea and vomiting.

Cognitive correlates of dental anxiety

This study examined cognitive correlates of dental anxiety among 24 highly anxious patients and 17 low-anxious patients. In both groups, anxiety expectations, dental trait anxiety, and state anxiety (in the waiting room and in the dental chair) were rated. Negative cognitions and cognitive control were also assessed. It was found that dentally high-anxious patients claimed to experience more negative thoughts than those with low anxiety (p < 0.001). None of the highly anxious patients reported relatively few negative cognitions, and none of the patients in the low-anxiety group reported relatively numerous negative cognitions. While patients from both groups reported that cognitive control declined with the imminence of treatment, highly anxious patients were found to have less control over their negative thoughts (p < 0.001). A series of stepwise regression analyses revealed that both the number of negative cognitions and perceived cognitive control accounted for 75% of the variance in dental trait anxiety. The results of the present study suggest that cognitive activities, such as negative thinking (catastrophizing) and cognitive control, are important moderators of dental anxiety.

Appraisal of dental anxiety and fear questionnaires: a review

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. It 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 and characteristics of dental anxiety in Danish adults

Prevalence, characteristics and consequences of dental anxiety in a randomly selected sample of 645 Danish adults were explored in telephone interviews. Participation rate was 88%. Demographics, fear of specific procedures, negative dentist contacts, general fear tendency, treatment utilization and perceived oral conditions were explored by level of dental anxiety using a modified Dental Anxiety Scale (DAS). A Seattle fear survey item and a summary item from the Dental Fear Survey (DFS) were also included for fear description comparisons. Correlation between these indices (DAS-DFS: rs = 0.72; DAS-Seattle item: rs = 0.68) aided semantic validation of DAS anxiety intensity levels. Extreme dental anxiety (DAS > or = 15) was found in 4.2% of the sample and 6% reported moderate anxiety (DAS scores 14-12). Bivariate (B) and logistic regression (L) odds ratios (OR) showed that high dental anxiety was associated with gender, education and income, but not with age. Extreme dental anxiety for dentate subjects was characterized by fear of drilling (ORL = 38.7), negative dentist contacts (ORL = 9.3), general fear tendency (ORL = 3.4), avoidance of treatment (ORL = 16.8) and increased oral symptoms (ORB = 4.4). Moderate dental anxiety was also related to drilling (ORL = 22.3), but with less avoidance due to anxiety (ORL = 6.8) compared with low fear subjects.

Anxiety, pain and discomfort associated with dental treatment

The aims of the study were to describe the level of anxiety and pain/discomfort associated with dental treatment in two samples (N = 1288 and N = 2382) representative of an adult population, and to assess the statistical effects of these variables on utilization of dental services (dental attendance measures, expenditure, and items of dental treatment received during the last year). The prevalence of high dental anxiety in the samples as measured by Corah's Dental Anxiety Scale, the Dental Fear Scale, and the Dental Anxiety Question was 4.2%, 7.1% and 5.4%, respectively. Rather large proportions of the respondents judged dental treatment to be painful or uncomfortable: between 20 and 30% rated their last dental visit as moderately painful or worse; about 60% reported having had at least one very painful experience, and 5-6% experienced dental treatment in general to be very painful. Dental anxiety was significantly related to pain reports (correlations in the 0.32-0.48 range). There were no differences between the youngest age group (15-19 yr) and the rest of the respondents in Study II with regard to dental pain ratings. Possible explanations for these findings are discussed. The effects of dental pain and anxiety on utilization measures, although attaining significance in several of the analyses, were generally weak. Both studies demonstrated few significant differences between individuals with high dental anxiety and the rest of the study samples with respect to type and extent of dental treatment received during the last year. Thus, these data seem to show that many dentally anxious patients seek out and undergo dental treatment despite high fear levels.

The influence of social and ethnic factors on dental care habits and dental anxiety: a study in Israel

The purpose of the present study was to assess the influence of social and ethnic factors on dental care habits and dental anxiety in a group of children resident in Jerusalem, Israel. Four hundred and fifty-six children completed a questionnaire that included 21 questions: nine referred to socio-demographic variables, three concerned the children's dental care habits, and the remaining nine concerned dental anxiety. Social level was determined by the father's occupation and their area of residence. Ethnic background was established according to the mother's or grandmother's country of origin. Chi-squared tests revealed no significant differences between social class or ethnic origin and dental care habits or dental anxiety. Analysis of variance, however, revealed a significant difference between the anxiety reported by boys of the two ethnic groups studied. Dental care habits were good in the majority of the children of all backgrounds, and the level of dental anxiety was low in all groups. It was concluded that ethnic origin had an influence on dental anxiety only in boys, whereas ethnic origin and social class had no influence on dental care habits.

A radiographic study of dental health in adult patients with dental anxiety

The objective of this study was to compare the dental health in a group of 90 patients with severe dental fear (FP), aged 20-41, with that of a matched control group of ordinary dental patients (OP). All registrations were made from radiographic intraoral full mouth surveys. Mean number of missing teeth among FP and OP patients was 4.4 and 2.5, respectively. On average, FP patients had 19.5 decayed surfaces compared to 7.9 in OP patients. Mean number of filled surfaces was 13.1 and 8.1 in OP and FP patients, respectively. FP patients, on average, had significantly more periradicular bone lesions as well as pronounced marginal bone loss than OP patients. This study showed that dental fear patients in general have a substantially deteriorated dental health compared to ordinary dental patients. Moreover, different dental care habits were evident between FP and OP patients. A progressive severity in dental disease pattern was found among FP patients.

Clinical correlates of dental anxiety among older adults

Most studies of the relationship between dental anxiety and oral health status have used subjective rather than clinical indicators of oral health. In this paper we examine differences between older adults who are and are not dentally anxious using a broad range of clinical measures. The data show that dentally anxious individuals were more likely to be edentulous, and among the dentate, had more missing and fewer filled teeth. As a result, dentally anxious dentate subjects were more likely to need prosthodontic treatment. They were also more likely to need immediate treatment for the relief of pain and infection and periodontal care. There was evidence to suggest differences in patterns of dental treatment between those who were and were not dentally anxious and some evidence consistent with the hypothesis that aging influences the relationship between dental anxiety and oral health status.

Dental visit satisfaction in a group of adults aged 50 years and over

Studies have found that utilization of dental services is generally less common than utilization of medical services, particularly by older persons. Because satisfied dental patients were found to be greater users of the service than nonsatisfied patients, it was decided to investigate the correlates of dental visit satisfaction in older subjects. Predictions that satisfaction would be positively related to regular use of dental services and negatively related to dental anxiety were confirmed. The results also suggested that older dental patients have different expectations of their dentists than younger ones.

Dental anxiety and attendance in the north-west of England

The aim of this study was to record the level of anxiety and last recorded visit for a dental check-up of a random sample of 300 workers at three sites in the North-west of England. All subjects were asked to complete a short written questionnaire and 255 (85 per cent) usable forms were returned. The mean level of anxiety using the Corah Dental Anxiety Scale (DAS) (N.L. Corah, 1969, J. Dent. Res. 48, 596) was 9.1. Females had a statistically higher mean DAS than males but there was no correlation between DAS and either age or occupational status. Those subjects who claimed not to have had a check-up in the past year had a significantly higher mean DAS than those who claimed to have been in the past year. Multiple regression analysis showed that the reported time interval since the last check-up was the most important predictor of the DAS score. The implications of the results are considered for the future of restorative dentistry.

Attendance pattern of anxiety-treated dental patients: a pilot study

Ex-patients of a dental fear clinic were found to have significantly reduced, yet still high, dental anxiety scores in comparison with the pre-intervention scores. In spite of the intervention about one quarter of the ex-patients did not visit a dentist regularly. A positive relationship was found between dental anxiety, measured with Corah's DAS, and "dislike of drilling". A short duration of (self-reported) psychophysiologic anxiety reactions appeared to be associated with the intention to ask for treatment, e.g. if a cavity were present. However, regular dental attendance was not correlated with dental anxiety scores.

General and specific fears in referred and self-referred adult patients with extreme dental anxiety

The levels of, and relationships between, dental fear and general fears and phobias were studied in 109 adult patients at a specialized dental fear clinic using two dental fear scales (the Dental Anxiety Scale and the Dental Fear Survey) together with the Fear Survey Schedule II (FSS-II) and some additional fear items. Referred and self-referred fearful dental patients answered mailed questionnaires in conjunction to being put on a 1 yr waiting list for treatment. Among feared objects and situations the separate item 'pain' revealed the highest mean scores for both men and women, followed by fear of suffocating, death of a loved one and sharp objects among women, and death of a loved one, suffocating and hypodermic needles among men. With few exceptions, women scored higher than men. The frequencies of extreme fears (6 and 7 on a 7-point scale) were high and 92.7% of the patients reported at least one extreme fear. Half of the subjects (49.5%) reported five fears or more. It was also shown that a number of FSS-II items correlated to dental fear indicating a relationship between general and dental fear. These results indicated that a large proportion of these dentally fearful individuals were prone to fear-associated reactions and behaviors, which has previously been shown to negatively influence the prognosis of treatment.

Increased salivary cortisol in severe dental anxiety

The aim of the present study was to investigate the feasibility of saliva collection from highly anxious dental patients and to evaluate whether salivary cortisol concentrations could discriminate between 13 highly anxious dental patients and 13 non-anxious subjects. Whole mixed saliva was sampled by suction after stimulation with citric acid crystals. Salivary free cortisol levels were measured in duplicate by radioimmunoassay. Collection of saliva took 2-5 min and was not experienced as unpleasant. Salivary free cortisol concentrations were significantly elevated if the patients manifested anxiety according to the scores on the Dental Anxiety Scale. The measurement of salivary cortisol may be a convenient method for the assessment of dental anxiety.

The prevalence of dental anxiety in a group of 13- and 14-year-old Scottish children

The aim of this study was to determine the prevalence of dental anxiety reported by a group of 13- and 14-year-old children, and to explore the relationships between dental anxiety and general fear, social class, gender, size of family, length of time since the last dental appointment, and the number of people known by the child to be afraid of visiting the dentist. A group of 1103 children from eight schools took part in the study, which was completed in 1989. The children (mean age 14.0 years, SD 0.35) completed a structured questionnaire containing the Corah Dental Anxiety Scale (CDAS) and the Geer Fear Scale (GFS). The prevalence of high dental anxiety (CDAS greater than = 15) was 7.1%. High dental anxiety was associated with gender (girls having higher levels of anxiety than boys) and with social class as defined by father's occupation (lower social class groups having higher dental anxiety). Injection was the dental procedure most highly correlated with CDAS in children with a high dental anxiety, closely followed by 'drilling' and 'tooth scaling'. A high level of general fear (GFS) was associated with a high level of dental anxiety. Despite this, 64% of those with high dental anxiety had a low general fear. Two factors were useful predictors of high dental anxiety: the length of time since the last visit to the dentist and the number of people known by the child to be afraid of going to the dentist.

Assessment of dental fear. A comparison of two psychometric instruments

To analyze further dental fear and its presentation in dental patients, two psychometric instruments were distributed among 50 patients attending a dental emergency clinic (EMC) and 44 patients applying for treatment at a specialized dental fear clinic (FEC). The Dental Fear Survey (DFS) was compared with the Corah Dental Anxiety Scale (DAS). After separating the EMC patients into high- and low-fear individuals in accordance with DAS scores, analysis showed that DFS values also clearly distinguished between these groups and between the FEC group and EMC groups. The dental fear levels were in correspondence with previous results, and the correlation between the DAS and the DFS was high (r = 0.92). In contrast to the DFS avoidance and arousal dimensions, the difference between the mean item scores on the dental situation dimension was not significantly different between high-fear EMC and FEC individuals. This indicated that the evaluation and appraisal of the dental situation among high-fear EMC and FEC patients may have been corresponding, whereas the behavioral and physiologic effects were different. Thus, in spite of this similar appraisal of the dental situation, FEC patients were interpreted as showing a more phobic behavior, and this was better captured in the DFS than in the DAS.

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.

Optimism-pessimism dimension and dental anxiety in children aged 10-12 years

This study explored the relationships between Previous Dental Experience (PDE), Corah's Dental Anxiety Scale (DAS), the Dental Anxiety Question (DAQ), dispositional optimism as measured by the Life Orientation Test (LOT), and Clinical Behavioral Rating (CBR). The main purpose of the study reported here was to investigate the possible usefulness of the optimism-pessimism dimension in predicting clinical dental anxiety. 163 children aged 10-12 yr participated in the investigation. The results indicate that both self-reported dental anxiety and optimism-pessimism were unique contributers to prediction of behavioral ratings of dental anxiety.

Correlates of dental anxiety among older adults

This paper reports on a study of dental anxiety among adults aged 50 years and over living independently in two communities in Ontario, Canada. Subjects were identified by means of a telephone survey based on random-digit dialing. Data on dental anxiety were collected from 580 subjects by means of a self-completed questionnaire and were measured by the Dental Anxiety Scale (DAS) (Corah, 1969). The mean DAS score was 7.8, and 8.4% of subjects were classified as dentally anxious. Age was the only demographic factor associated with dental anxiety. Older individuals had lower DAS scores than younger individuals (p less than 0.0001). There was also a significant association between dental anxiety and general fearfulness measured by the Fear Survey Schedule II (Geer, 1965) (r = 0.31; p less than 0.001). A series of regression analyses revealed that dental anxiety was a significant predictor of a number of behavioral and oral health outcomes. While these results confirm that dental anxiety is less prevalent among older adults than in younger populations, it has a number of important consequences with respect to dental care provision.

The effect of concordance in the treatment of clients with dental anxiety

This study followed from an earlier case study in which an agoraphobic client was treated daily for a period of four weeks by in vivo exposure. Ratings of his perceived anxiety responses in the behavioural, cognitive, and physiological systems were monitored throughout treatment. Concordance between these ratings was associated with positive outcome. This study was an attempt to replicate some of these findings. A group programme involving four sessions in which clients were taught anxiety management skills, exposed in imagination to situations relating, to dentistry, and given homework assignments was carried out with clients presenting with disproportionate dental anxiety. The subjects were obtained by means of local newspaper and radio advertisements and randomly assigned to a massed or spaced treatment condition. It was predicted that the massed condition involving shorter intersession intervals would be superior at producing habituation and concordance than the spaced condition. The results failed to show differences between the massed and spaced treatment condition with regard to concordance and outcome. However, it was confirmed, once more, that concordance between the three modes of anxiety responding was positively related to outcome.

Assessment of a single-item dental anxiety question

This paper discusses issues related to the validity and usefulness of a single-item measure of dental anxiety: The Dental Anxiety Question (DAQ) 'Are you afraid of going to the dentist?'. A nationwide random sample of 1351 people aged 15-79 years answered the DAQ and Corah's Dental Anxiety Scale (CDAS). In addition, the respondents were categorized with regard to gender, age, geographic areas, and residential districts. The internal consistency reliability coefficient for CDAS was high (alpha = 0.91), and DAQ correlated highly with all of the four items on the CDAS (mean, r = 0.71). The correlations between the DAQ and the CDAS were high for men, women, and between age groups (r = 0.74-0.86). Women had significantly higher mean values on the DAQ than men in all age groups, and for both genders the mean DAQ values decreased with increasing age. The DAQ mean values were insignificantly different across geographic areas and residential districts. The conclusion is drawn that the DAQ shows promising qualities as a reliable and valid measure of the overall dental anxiety in the Norwegian adult population.

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.

Anxiety and blood pressure prior to dental treatment

In the present study dental anxiety and blood pressure were assessed immediately prior to a dental appointment to assess the relationship between self-reported dental anxiety and blood pressure. Blood pressure was assessed by two independent methods, and the interchangeability of the blood-pressure measurement methods was also assessed. No relationship was demonstrated among scores on three dental anxiety questionnaires and blood-pressure values. The blood-pressure measurement methods delivered comparable values for diastolic and mean arterial blood pressure only.

Prevalence of dental anxiety in The Netherlands

The main purpose of this study was to investigate the prevalence of dental anxiety in the Netherlands by means of both a nationwide representative sample and a valid measurement instrument. The secondary aim was to discriminate between patients with high and low levels of dental anxiety on the basis of socioeconomic and oral health variables. Results showed that about 40% of the Dutch population experience a considerable degree of anxiety about dental treatment, and more than half of them can be considered as highly anxious. Dental anxiety is related to sex, age, and oral health status. Individual most prone to experience dental anxiety are women between 26 and 35 yr of age who do not visit a dentist regularly, live in one of the big cities, have a moderate or high educational level, are Public Health Insurance (Ziekenfonds) patients with a minimum income, judge their oral health as bad, and do not attach much importance to the preservation of their teeth.

A 10-year follow-up of patients treated for dental fear

Different types of treatment have been used in trying to reduce dental anxiety in adult patients with severe fear and avoidance behavior. However, there is an obvious shortage in long-term treatment follow-up. The present investigation reports results over a period of 10 yr of 14 patients treated for dental fear in a specialized dental fear treatment and research clinic. The aims of this project were to evaluate patients' regularity in dental behavior between 1977 and 1987, changes in and present level of dental fear and other long-standing positive/negative effects of the respective initial treatments. The 14 dental phobic patients were assigned to two treatment groups, one receiving Systematic Desensitization and one Premedication with valium before dental treatment. Pre- and posttreatment status as well as the 10-yr follow-up were evaluated by psychometric (Corah's Dental Anxiety Scale and a Mood Adjective Checklist) and physiological (Skin Conductance Response) measurements. A majority of patients (100% SD, 63% P) reported regular dental care during the period 1977-87. Positive side-effects were reported by seven patients. A significant reduction of dental fear (DAS) was found with a better effect for the SD-group. This was paralleled by a rise in mood (MACL). The SCR figures were non-significant. In conclusion, the results revealed long-standing effects with regard to a high degree of regular dental care and reduction of dental fear. In addition, positive side-effects were reported.

Predictions of dental pain: the fear of any expected evil, is worse than the evil itself

In a study of 40 subjects, who twice underwent extensive dental treatment, the relationships between expectations and experiences of pain and of anxiety were investigated. Inaccurate expectations were adjusted in the same way as observed in the laboratory. Especially anxious subjects expected more pain and anxiety than they experienced, and they appeared to need more experiences before their predictions became accurate. In the course of time, the expectations (and memories) of anxious subjects returned to their original more inaccurate level of prediction. The results suggest that the old schema is ultimately reinstated if disconfirmations are few and far between. Anxious subjects did not experience more pain, but they did experience more anxiety than fearless subjects. Detailed investigation of processes of change after disconfirmation showed that anxiety experienced during treatment is a factor that plays a part in maintaining the problem of inaccurate expectations and fear of treatment. Theoretical and clinical implications of these findings are discussed.

Attitudes of some young female bank employees to dentistry

Structured interviews were undertaken with one hundred 18-30-year-old females, seeking their views on dental care. Almost all regarded their own past experience as affecting their general level of dental anxiety. Over half were anxious about visiting the dentist and almost all of these were anxious before entering the surgery. The Anxious emphasized the negative features in dental care and the practice environment whereas the Non-anxious concentrated on positive features, particularly their relationship with the dentist. Many spontaneously commented that their attitudes had been improved by changing dentists, although some still remained anxious. 'Worst visits' had frequently occurred early in their lives. Appearance was of prime importance; function was ignored. Interviewees believed that visiting the dentist would be eased by lower costs, more convenient hours, better surroundings in the practice and improved techniques to make dentistry more comfortable.

Power and pain: the location of pain and fear in dentistry and the creation of a dental subject

It has been argued that the meaning of pain in childbirth and in general medicine has changed and that this change was part of a cognitive transformation that occurred in medicine during the post World War II period. This paper uses Foucault's notion of the gaze and his unique conception of power to explore the extent to which the understanding of pain, and the associated concept of fear, in dentistry, reflects those understandings found in medicine and obstetrics. Within the discourse of dentistry the conception of pain is both object and effect of the profession's techniques of observation and analysis. Analyses of pain and fear occurred on two levels: the micro-level of the individual and the macro-level of the population. The examples of the case history and the epidemiological survey are used to demonstrate these two levels of power/knowledge. The first technique contributed to the constitution of the psychological space, the second technique confirmed the social space. Within these spatialisations new conceptualisations of pain were realised and a subjective dental subject was manufactured. The findings of this paper add weight to the thesis that the functioning of power/knowledge transcends professional and disciplinary boundaries and is a process which is far more subtle and fundamental than one of political manoeuverings by interested groups or individuals or the accumulation of an increasingly sophisticated knowledge.

Self-efficacy and the control of anxious cognitions

This study was designed to explore the possibility that Bandura's notion of self-efficacy can be applied to control over cognitions as well as behavior. Subjects were asked to complete questionnaires designed to measure their dental anxiety, the number of their negative self-statements about a dental appointment and their perceived ability to control these thoughts. Subjects with low anxiety claimed to experience fewer negative thoughts than those with moderate or high anxiety, and also to have more control over these thoughts. Subjects believed that the extent of their control would decline as the appointment approached in time, but least for the low anxiety group and most for the high anxiety group. Finally, differences in self-efficacy scores between anxiety groups were maintained when the number of negative thoughts was controlled for, but differences in negative thinking between anxiety levels were not maintained when self-efficacy was controlled for. These results suggest that anxiety is more closely related to thinking processes than content.

Reduction of dental fear: psychophysiological correlates

EMG, HR and SCR were continuously recorded during two Standardized Dental Examinations (SDE) of 15 dental phobics. Following the first SDE, the patients were assigned to two treatment groups, one receiving systematic desensitization followed by two separate amalgam restorations and one premedicated with Valium for the two restorations. The dentist rated the patients' behavior on a 5-point scale. Corah's Dental Anxiety Scale (DAS) was used prior to the first SDE and following the second SDE. The second SDE was conducted on a separate occasion following the second restoration. No significant correlations were found between any of the physiological measures and either the dentist's ratings or the second DAS or DAS change scores. Significant differences found between the two treatment groups on the dentist's ratings, second DAS, and change scores were not reflected by the physiological measures.

Clinical measurement of dental anxiety

The mean scores on five dental anxiety measurements of 60 patients suffering from extreme dental anxiety are compared with those of an equal-sized, matched group of regular dental attenders free from dental anxiety. Four of the measurements, especially Corah's DAS, appear to be suitable for distinguishing persons suffering from extreme dental anxiety. Also, persons with extreme dental anxiety appear to express their fear openly.

Anxiety and dental fear in a group of parenteral drug addicts

The aim of the study was to evaluate whether general anxiety and dental anxiety were more common in a group of parenteral drug addicts. 41 drug addicts (mean = 27.4 yr) attending a dental clinic in Aarhus in Denmark participated. A randomly sampled reference group comprising 350 individuals living in Aarhus and with similar age distribution was selected from the Central Person Register. Questionnaires with social and educational data and three self-report rating scales, namely Corah's dental anxiety scale (CDAS) and Spielberger's State-Trait anxiety inventory's two scales (STAI-State and STAI-Trait) were completed by the participants. Response rates were 95.6% and 89.3% for drug addicts and controls, respectively. Median CDAS, STAI-State, and STAI-Trait were 10, 46 and 44 in the addicts which was statistically significantly higher than in the general population. These differences were still present when the addicts were compared to a subsample from the reference group with a better matching of educational and social background factors. Spearman's correlation coefficient between CDAS and STAI-State, CDAS and STAI-Trait, and STAI-State and STAI-Trait were 0.57, 0.49 and 0.50, respectively, which were significant and moderately high correlations. Finally, anxiety levels were similar irrespective of caries experience.

Influence of repression upon the measurement of dental anxiety

Using a non-linear, multivariate analysis, the resistance against admitting to being dentally anxious was studied. Dental anxiety was found to be repressed by a subgroup, among them more men than women, of a sample, who also repressed the feeling of low self esteem about tooth loss. Based on the results, regular and irregular dental attenders can be separated almost perfectly. The relationship with other anxiety measurements, i.e. Corah's Dental Anxiety Scale and three components discernible in Weiner's Anticipation Anxiety Level Chart, was studied.