Translation and psychometric properties of the Swedish version of the Index of Dental Anxiety and Fear (IDAF-4C+)

Psychometric Assessment of the Romanian Version of the Index of Dental Anxiety and Fear (IDAF-4C+)

BACKGROUND AND OBJECTIVES

The goal of this study was to assess the validity of the Romanian version of the Index of Dental Anxiety and Fear (IDAF-4C+) questionnaire.

MATERIALS AND METHODS

This study was conducted on a convenience sample of past patients and their acquaintances through an online questionnaire administered on the Google Forms platform between May 2021 and September 2022. The sections of the survey were demographic characteristics, the dental anxiety scale questionnaire, the IDAF-4C+ questionnaire, a single question about dental fear, and previous dental treatments.

RESULTS

In total, 239 participants were included in the study, and the mean age was 37. The IDAF-4C questionnaire had good internal validity (Cronbach alpha was 0.945). The IDAF-4C had good convergent validity, and it was positively correlated with the dental anxiety scale (r = 0.825, p < 0.001) and the question about the fear of going to the dentist (r = 0.738, p < 0.001). The questionnaire had good reliability, and the intraclass correlation was 0.985. Lower levels of dental anxiety were associated with scaling, orthodontic treatment, and dental implants. A confirmatory factor analysis was conducted after the removal of the first question from the phobia module, and residual covariance was added between items four and nine of the stimulus module, showing a good fit for the retained questions of the IDAF-4C+, grouped by module.

CONCLUSIONS

The Romanian version of the IDAF-4C+ showed acceptable psychometric properties.

Dental fear and anxiety in Asian youths: response components and inducing stimuli

OBJECTIVES

This study estimated the prevalence of dental fear/anxiety (DFA) and phobia in Asian youths and investigated the fear/anxiety response components and triggers for those with DFA.

MATERIALS AND METHODS

A convenience sample of youths, aged 17 to 24 years old, was recruited from a local polytechnic. The Index of Dental Anxiety and Fear-4C + (IDAF-4C +) was employed to assess the occurrence of DFA (IDAF-4C) and phobia (IDAF-P) as well as to ascertain fear/anxiety-inducing stimuli (IDAF-S). Psychological distress was determined with the Patient Health Questionnaire-4 (PHQ-4). Sociodemographic, IDAF-4C + , dental attendance patterns, and PHQ-4 data were gathered electronically. Statistical analyses were conducted with chi-square, Kruskal-Wallis, and relevant post hoc tests (α = 0.05).

RESULTS

A total of 215 participants were enrolled (mean age of 18.9 ± 2.0 years; 87.4% women). Of these, 12.6/6.0% had moderate-to-high (MH)/high-to-extreme (HE) DFA and 0.9% experienced dental phobia. Significant differences in scores were observed between the HE/MH and no-to-moderate (NM) groups for all IDAF-4C components. Apart from the cost of dental treatment, IDAF-4S scores varied significantly among the three DFA groups. The two most highly rated DFA stimuli were painful/uncomfortable procedures and needles/injections for the HE group, while they were needles/injections and the cost of dental treatment for the MH and NM groups.

CONCLUSIONS

Moderate-to-extreme DFA existed in 18.6% of the Asian youths examined. The emotional and physiological components of the IDAF-4C appear to contribute more to the DFA response. Dental pain including needles/injections and the cost of dental treatment troubled Asian youths the most.

CLINICAL RELEVANCE

DFA is a common problem among Asian youths, and understanding its extent, nature, and triggers is central for effective interventions.

Dental anxiety treatment by a dentist in primary care: A 1-year follow-up study

In an earlier randomized controlled trial of dental anxiety treatments (n = 96) we compared the effects of dentist‐administered cognitive behavioural therapy (D‐CBT) and dental treatment supplemented with the Four Habits communication model plus midazolam sedation. Both treatments, applied in a general dental practice, were associated with a clinically relevant decrease in dental anxiety. In this follow‐up study, 52 of the 82 treatment completers responded to an online questionnaire 1 year post‐treatment. Reduction in dental anxiety persisted for both treatment groups. From baseline to 1 year post‐treatment the Modified Dental Anxiety Scale was reduced by 7.8 [SD: 4.4; Cohen's d effect size: 1.2 (CI: 0.8–1.7)] and 7.8 [SD: 4.2; Cohen's d: 1.4 (0.9–1.8)] in the D‐CBT and Four Habits/midazolam groups, respectively. Most patients (74% for D‐CBT, 80% for Four Habits/midazolam) continued with dental treatment. Nine patients in the D‐CBT and seven in the Four Habits/midazolam groups received additional CBT treatment from a psychologist/dentist team. Both methods tested should be accessible to interested dentists who receive adequate training. Effective first‐line treatments for dental anxiety in general dental practice can generate more accessible care pathways for patients with dental anxiety. Evidence‐based dental anxiety treatment programmes should be included in the dental curriculum and established as best practice for dentists.

Dentist-administered cognitive behavioural therapy versus four habits/midazolam: An RCT study of dental anxiety treatment in primary dental care

The study aimed to test the effectiveness of cognitive behavioural therapy (CBT) administered by a general dental practitioner (GDP) in a general dental practice. In a two-arm parallel randomised controlled trial, the experimental group received a short dentist-administered CBT-intervention (D-CBT). A best-practice control group (FHM) received dental treatment during sedation with midazolam combined with an evidence-based communication model (The Four Habits Model). Ninety-six patients with self-reported dental anxiety were allocated to the treatment arms at a 1:1 ratio. Modified Dental Anxiety Scale (MDAS) scores spanned from 12 to 25, and 82 patients (85%) had a score of 19 or more, indicating severe dental anxiety. In both treatment arms, scores on MDAS and Index of Dental Anxiety and Fear (IDAF-4C) decreased significantly, but no differences were found between treatment arms. Mean reductions were: MDAS scores: -6.6 (SD = 0.5); IDAF-4C scores: -1.0 (SD = 1.1). In conclusion, local GDPs in general dental practices with proper competence have the ability for early detection of dental anxiety and, with the use of a manual-based D-CBT or FHM treatment, GDPs could offer efficient first-line treatment suitable for dental anxiety of varying severities.

Psychometric Assessment of the Urdu Version of the Index of Dental Anxiety and Fear

Background

The objective of the current study was to adapt the Index of Dental Anxiety and Fear (IDAF-4C) in the Urdu language and measure its validity and reliability.

Methods

Original English questionnaire of IDAF-4C was translated into Urdu language by a panel of dentists and language experts (Urdu and English) followed by critical evaluation, modification and back translation into English language. A final Urdu questionnaire was distributed among 250 patients visiting the Endodontics section at Margalla Institute of Health Sciences (MIHS), Rawalpindi, Pakistan. Cronbach’s alpha was used to determine the reliability of the Index whereas validity was assessed by exploratory factor analysis (EFA). Mean rank scores of IDAF-4C for male and female participants were evaluated using Mann-Whitney U tests (P < 0.05).

Results

Of 250 questionnaires, 209 were returned with a response rate of 84%. Cronbach’s alpha for the Urdu version of IDAF-4C was 0.88. Exploratory factor analysis of the IDAF-4C revealed one factor explaining 55.55% of the common variance (Eigenvalue = 4.5). The mean rank scores of all eight items of IDAF-4C were greater for female participants as compared to male participants with a statistically significant association (P < 0.05).

Conclusion

The psychometric analysis of the Urdu version of IDAF-4C showed good reliability and consistency compared to the original version as well as other translated versions.

Evaluation of the Jönköping dental fear coping model: a patient perspective

OBJECTIVE

This study is a part of a project with the aim to construct and evaluate a structured treatment model (the Jönköping Dental Fear Coping Model, DFCM) for the treatment of dental patients. The aim of the present study was to evaluate the DFCM from a patient perspective.

MATERIAL AND METHODS

The study was performed at four Public Dental Clinics, with the same 13 dentists and 14 dental hygienists participating in two treatment periods. In Period I, 1351 patients were included and in Period II, 1417. Standard care was used in Period I, and in Period II the professionals had been trained in and worked according to the DFCM. In the evaluation, the outcome measures were self-rated discomfort, pain and tension, and satisfaction with the professionals.

RESULTS

In comparison with standard care, less tension was reported among patients treated according to the DFCM, (p = .041), which was also found among female patients in a subgroup analysis (p = .028). Additional subgroup analyses revealed that patients expecting dental treatment (as opposed to examination only) reported less discomfort (p = .033), pain (p = .016) and tension (p = .012) in Period II than in Period I. Patients with low to moderate dental fear reported less pain in Period II than in Period I (p = .014).

CONCLUSIONS

The DFCM has several positive effects on adult patients in routine dental care. In a Swedish context, the differences between standard care and treatment according to the model were small but, in part, statistically significant. However, it is important to evaluate the model in further studies to allow generalization to other settings.

Development of the Turkish version of the Index of Dental Anxiety and Fear (IDAF-4C+): Dental anxiety and concomitant factors in pediatric dental patients

OBJECTIVE

The aim of this study was to develop the Turkish version of the Index of Dental Anxiety and Fear (IDAF-4C⁺) and also to explore factors associated with dental anxiety in clinical pediatric dental patients (PDPs).

STUDY DESIGN

The study sample consisted of 421 PDPs aged 12-14, 104 of whom were selected for test-retest analysis. The psychometric evaluation included linguistic validity, exploratory factor analysis, reliability by internal consistency (Cronbach's alpha) and test-retest reliability (intra-class correlation coefficient, ICC). Construct validity was tested by comparing a commonly used instrument, the Children's Fear Survey Schedule Dental Subscale (CFSS-DS). Associations between parental dental anxiety, frequency of dental visits, dental caries, dental visit behaviour and children's dental anxiety were also examined.

RESULTS

The Turkish version of the IDAF-4C demonstrated good internal consistency (Cronbach's alpha α=.96) and test-retest reliability (ICC=.87). Factor analysis showed a fit IDAF-4C model with a single factor, 8 items. Dental anxiety scores were significantly correlated with all measured variables (p<0.001). Girls showed significantly higher dental anxiety scores than boys (p<0.05).

CONCLUSIONS

This study suggests that the Turkish version of the IDAF-4C⁺ is a valid and reliable instrument for assessing dental anxiety and fear in Turkish children.

Development and evaluation of the Jönköping Dental Fear Coping Model: a health professional perspective

OBJECTIVE

The purpose of this study was to design a structured treatment model focusing on all levels of adult's dental fear, the Jönköping Dental Fear Coping Model (DFCM). The aim was to study the DFCM from a dental health professional perspective.

MATERIAL AND METHODS

The DFCM was studied by means of quantitative and qualitative analyses. Nine dental clinics participated in Period I (pre-intervention/standard care), and 133 dental health professionals (dentists, dental hygienists, dental assistants) and 3088 patients were included. After completion of Period I, four of the clinics were randomized to Period II (intervention), beginning with the professionals undergoing DFCM training. Following that, 51 dental health professionals treated 1417 patients according to the DFCM. The other five clinics served as controls.

RESULTS

Half or more of the dental health professionals assessed the model as better than standard care, regarding anamnesis and diagnostics, communication and contact, and understanding of patients and dental fear. The dental health professionals reported higher tension in their fearful patients in Period II compared with Period I, possibly due to their increased awareness of dental fear.

CONCLUSIONS

The qualitative data suggest that dental health professionals find the DFCM beneficial in routine dental care. The model promotes a holistic approach to the treatment of adult patients. However, stress among the professionals was not reduced when measured, neither quantitatively nor qualitatively. It is important to evaluate the model in further studies to make it possible to draw generalizable conclusions.

Translation and validation of the Finnish version of index of dental anxiety and fear (IDAF-4C+) among dental students

BACKGROUND

Dental fear accounts for 41% of the non-habitual dental attendance such as visiting only when in pain among adult Finns. Dentists should be able to recognize patients in risk for irregular attendance due to dental fear and measure their fear with valid and reliable instrument that capture the multidimensionality of dental fear. The study's aim was to translate the Index of Dental Anxiety and Fear (IDAF-4C+) into Finnish and test its reliability and validity.

METHODS

The study population consisted of dental students in a Finnish university (n = 202). The IDAF-4C⁺ was back-and forward translated by experts as well as a native English translator, blinded to the original version. Reliability was assessed using Cronbach's alpha. Validity of the IDAF-4C⁺ was assessed against the Modified Dental Anxiety Scale (MDAS) using Spearman correlation coefficients and through the use of Exploratory factor analysis (EFA) and between genders using Mann-Whitney U tests.

RESULTS

The reliability of the IDAF-4C⁺ was good, the Cronbach's alpha being 0.88. The IDAF-4C⁺ and MDAS and their subscales were correlated, with coefficients varying between 0.34 and 0.85. Correlations were stronger with the emotional and physiological components of the IDAF-4C⁺. EFA revealed one factor explaining 51.7% of the common variance (eigenvalue = 4.6). Women tended to have slightly higher mean scores than men (1.49 vs. 1.36, p = 0.247).

CONCLUSIONS

The translation and localization of the Finnish version of the IDAF-4C⁺ can be considered as providing some evidence of the validity and reliability of the scale. It adds to previously used measures as it considers also the behavioral, cognitive and physiological dimension involved in dental fear.