Factors affecting dental anxiety and beliefs in an Indian population

Using the Expanded Andersen Model to Determine Factors Associated with Mexican Adolescents' Utilization of Dental Services

Many factors contribute as facilitators of or barriers to adolescents' use of dental services. Guided by the expanded Andersen model for dental service utilization, the aim of this study was to identify factors associated with the use of dental services among adolescents ages 12-16 in south Mexico City (n = 247). Adolescents answered a questionnaire on predisposing factors (age and gender), enabling factors (socioeconomic status, oral health support, parental years of education, and previous dental treatments), and psychosocial and behavioral factors (attitudes towards oral health; knowledge of gingivitis; alcohol, drug, and tobacco use; and depressive symptoms), and they underwent a visual clinical exam to determine their need factors (caries and gingivitis). The adolescents reported whether or not they had attended a dental visit in the last year for any reason. Multiple logistic regression was used to evaluate these factors. Having oral health support increased the odds of a dental visit by 2.69 (95% CI = 1.24-5.84). Previous dental treatment increased the odds of a dental visit by 2.25 (95% CI = 1.12-4.52). The presence of depressive symptoms reduced the odds of a dental visit by 4% (OR = 0.96, 95% CI = 0.94-0.99). Enabling and psychosocial factors of oral health support and previous dental treatment were positively associated with the utilization of dental services, while depressive symptoms were negatively associated.

Factors Associated with Patients' Rejection of Root Canal Treatment in a Tertiary Hospital, Southwest Nigeria: A Pilot Survey

Objective

Root canal treatment (RCT) is a major procedure in dentistry. It aims to relieve the pain of pulpal origin and maintain the affected tooth as a functional unit on the arch. Despite these achievable goals, RCT is sometimes rejected by patients. This study, therefore, sought to assess the reasons for rejection in patients planned for endodontic/RCT.

Materials and Methods

This was a cross-sectional pilot survey of patients planned for RCT using a self-administered questionnaire. The questionnaire included sociodemographics, the Index for Dental Anxiety and Fear (IDAF-4C), and questions to assess the reasons for rejection of endodontic treatment. Data collected were analysed with IBM Statistical Package for the Social Sciences software program, version 23.0. Descriptive statistics were used; chi-square was used to test the association between categorical variables. Statistical significance was set at P ≤ 0.05.

Result

Thirty-one patients between the age range of 16 and 81 years, with a mean age of 38.16 ± 17.87, participated in the survey. Only nine (29.03%) of the participants declined to have the treatment. The majority 6(66.7%), and 7(77.8%) of those that refused the treatment did so, due to fear of drilling (P = 0.014) and cost of treatment (P = 0.001), respectively. Mean IDAF-4C was 1.86 ± 0.9 (standard deviation).The rejection was, however, not affected by past experience, the risk of taking multiple radiographs, and the number of hours or visits for the procedure.

Conclusion

The cost of treatment and fear of drilling were the major reasons for the rejection of RCT in this study. Therefore, there is a need to further look into making endodontic treatment a more comfortable, less costly, and less fear-provoking procedure for patients.

Prevalence and Socio-Demographic Correlates of Dental Anxiety among a Group of Adult Patients Attending Dental Outpatient Clinics: A Study from UAE

OBJECTIVES

The aims of this paper were twofold: first, to evaluate dental anxiety levels among patients undergoing oral surgery procedures; second, to assess how dental anxiety and fear are connected to age, gender, educational background, past traumatic experiences, and the frequency of dental appointments.

METHODS

A cross-sectional Likert-scale questionnaire survey was conducted to collect quantitative data from 206 patients at the Oral Surgery Clinics at Dubai Dental Clinics, Dubai, United Arab Emirates. The reliability and validity of the questionnaire were tested using Cronbach's alpha. The normality of the MDAS score was tested using the Kolmogorov-Smirnov test. The chi square and Kruskal-Wallis tests were used to determine the association between categorical variables. Descriptive statistics were used to describe continuous and categorical variables. The statistical significance was set at p-value ≤ 0.05.

RESULTS

The evaluation of the degree of dental anxiety among patients who visited the Dubai Dental clinics revealed that there was a considerably high level of moderate or high anxiety (72.3%). Tooth extraction and dental surgery procedures (95%), followed by local anesthetic injection in the gingiva (85%) and teeth drilling (70%), were the primary causes of anxiety, whereas scaling and polishing resulted in the lowest degree of anxiety (35%). There was no substantial difference in dental anxiety between male and female patients or among patients with different marital statuses. A total of 70% of patients preferred the tell-show-do method, whereas 65% chose communication strategies to reduce dental anxiety.

CONCLUSIONS

The evaluation of the degree of dental anxiety among patients who visited Dubai Dental clinics revealed that there was a considerably high level of anxiety. Tooth extraction and dental surgery procedures, followed by local anesthetic injection and teeth drilling, were the primary causes of anxiety, whereas scaling and polishing resulted in the lowest degree of anxiety. Despite the use of a modified anxiety scale and a large and representative sample of oral surgery patients, more research is necessary to investigate the impact of various factors on dental anxiety.

To assess the prevalence of dental anxiety among patients visiting a teaching dental hospital in Lucknow, India and their self-perceived treatment needs

Image 1 Patients self assessment was a good predictor of patient dental status.

Psychometric Properties of the Hebrew Modified Dental Anxiety Scale in Adult Israeli Population

Dental anxiety results in the neglect of oral hygiene and poor oral health, requiring an accurate screening tool for dental practitioners to evaluate dental anxiety. The Modified Dental Anxiety Scale (MDAS) is frequently used cross-culturally. The present study aimed to assess the reliability and validity of the Hebrew version of the MDSA. A total of 553 (mean age 35.87 years, SD = 13.14) Israeli participants were recruited through means of social media, mailing lists, and forums. The sample was randomly divided into two population sets. Dental anxiety was evaluated using the Hebrew version of the MDAS. The psychometric evaluation consisted of exploratory factor analysis (study 1, n = 274) and confirmatory factor analysis (study 2, n = 279). Cronbach’s alpha coefficient was used to assess internal consistency. Results showed high internal consistency (0.93) for the Hebrew version of the MDAS. Confirmatory factor analysis showed a single factor solution. Findings demonstrated 13.4% of Israeli participants with dental anxiety. Younger participants, females, participants with lower education, lower income, and more religious participants reported higher dental anxiety. In conclusion, the Hebrew version of the MDAS demonstrated high reliability and validity. It is recommended to use the Hebrew version of the MDAS to evaluate dental anxiety in Israeli dental settings.

Association of Fear and Annoyance with Acoustic Levels of Dental Equipment Among Adolescents Attending Rural Dental Health Center: A Cross-sectional Study

Introduction:

Noise is increasingly becoming pervasive in occupational health concerning practicing dentists as well as patients. A stimulus such as noise from dental equipment compared to anxiety is often multifactorial and can result from a combination of fear of pain, dental instruments noise, or even upcoming negative events and future threats.

Aim:

This study aimed to assess fear and annoyance levels among adolescents attending a rural dental health centre and compare the acoustic noise levels of dental equipment and its association with fear and annoyance levels among adolescents.

Methods:

The acoustic noise spectra originating from different tools/equipment in a rural dental health centre is assessed using an application named sound meter of a standard mobile android phone (Samsung galaxy grand 2). Following a 15-minute treatment, a questionnaire was filled by a professional investigator through personal interviews with all subjects. The data is subjected to analysis by Statistical Package for Social Sciences version 22.0.

Results:

61.5% of the subjects felt anxious about the anticipatory dental visit, and there was a significant difference observed between genders. Chi-square analysis revealed no significant differences in the fear and annoyance with increasing noise levels in various treatment groups. (p> 0.05).

Conclusion:

In the present study, fear and annoyance levels increased with increasing noise levels of equipment. Annoyance was found to be significantly higher in females.

Development of Modified Dental Beliefs Scale Among an Adolescent Rural Population

Objective

Modified dental beliefs scale (MDBS), the shortened form of the R-DBS, was developed in a multicultural population. The factor structure of MDBS is not explored in an Indian context. The study explores psychometric properties and tests the fit of MDBS in a rural costal adolescent population in a vernacular language.

Materials and Methods

The cross-sectional analysis was carried out at two randomly selected rural Institutes in Costal Karnataka. Psychometric properties using a questionnaire were assessed. Validity and reliability were assessed by Cronbach's α, split-half reliability, and test-retest analysis. Statistical analysis: Factor analysis with varimax rotation was employed to add a level of statistical precision and assist in the development the instrument. Two models were developed and tested for goodness of fit, root mean square error of approximation, and comparative fit.

Results

The MDBS revealed a Cronbach's α value of 0.76. Split-half reliability and Guttman split-half reliability were found to be 0.86 and 0.86, respectively. Test-retest reliability was found to be 0.74 (P < 0.01). Factor analysis revealed a five-factor solution explaining 67.8% of the variation in the scale. CFA revealed an appropriate goodness of fit for both models with better values for model two with chi-square value was statistically significant and the ratio value (χ²/df = 7.8).

Conclusion

The results of the present study indicate that the MDBS is a reliable and valid tool for the present population subset, with good fit for the second model with two separate latent variables.

Dental Fear and Patient Preference for Emergency Dental Treatment Among Adults in COVID-19 Quarantine Centers in Dammam, Saudi Arabia

PURPOSE

Dental fear is associated with the avoidance of dental visits and negative oral health outcomes. It is important to assess distribution of dental fear and preference for emergency dental treatment among adult population during COVID-19. Therefore, the purpose of this study was to evaluate dental fear and emergency dental treatment among adults in COVID-19 quarantine centers in Greater Dammam, Saudi Arabia.

MATERIALS AND METHODS

Male and female adults (N=606) in quarantine centers for COVID-19 participated in this cross-sectional study (June-July 2020). Dental Fear Survey was used to collect data on dental fear. The participants also provided their responses about emergency dental treatment/dental attendance patterns in addition to demographic information.

RESULTS

The mean DFS score of the sample was 39.08 ± 19.47, and 23.1% of the participants were a little fearful and 22.6% were highly fearful. About 36.8% reported that they would prefer to visit a dental office in case of dental emergency mostly for dental pain and fractured tooth during the COVID-19 pandemic. Only 10.4% of the participants reported visiting a dentist in less than 3 months, 35.8% in less than 6 months, 52.5% between 6 and 12 months and more, and 1.3% never visited the dentist. DFS scores significantly differed among participants who visited the dentist in less than 3 months (31.86 ± 14.57), less than 6 months (37.70 ± 18.57), between 6 and 12 months and more (40.78 ± 20.23), and never visited the dentist (65.75 ± 14.74) (P < 0.001). The timing of last dental visit (P < 0.001), female gender (P 0.039), and dental pain (P < 0.001) were the significant predictors of dental fear.

CONCLUSION

Dental fear was common among adults with a predilection for the female gender. Increased dental fear was significantly related to dental pain and reduced dental attendance. Only one-third of adults were willing to perform emergency dental visits.

Evaluation of Dental Anxiety and Fear in Patients who Admitted to the Faculty of Dentistry: Which Patients are More Risky in terms of Dental Anxiety

Background

Dental anxiety and fear make the dental operation and the treatment difficult. Beside that it causes the delays or absence in the dental appointments so it leads to problems for oral and dental health. The aim of this study was to investigate the frequency of dental anxiety, the factors affecting dental anxiety and the effects of dental anxiety on oral dental health of the participants.

Methodology

We conducted a hospital-based, cross-sectional study among 342 patients attending the outpatient clinic of a tertiary dentistry hospital. Dental anxiety and trait anxiety levels of the participants measured using MDAS and STAI scales. We conducted the student t-test, One-way Anova and Tukey's post hoc for the analysis of our data. The Pearson's correlation analysis has been used for the analysis of two different quantitative data obtain from MDAS and STAI scales.

Results

The age average of 342 participant of our research was 34,41±11,78. 59,1% of our participants was women. (n=202) Dental anxiety was existing in the 42,1% of the participants (n=144). 56,4% of the participants have had a hard and painful dental treatment experiences. 15,2% of our participants (n=52) had MDAS 19 point or more.

Conclusions

High and statistically significant dental anxiety scores have been detected for the patients who are women, housewives, who had uneasy and painful dental treatment stories, who have personel inclinations to the anxiety. Examinations directed to the factors which would increase the dental anxiety, may prevent possible complications and also the risk carried by the patients related to the dental health may be estimated with the help of this kind of examinations.

Gender differences in adolescents' perceptions toward dentists using the Japanese version of the dental beliefs survey: a cross-sectional survey

Background

While adult women show greater dental anxiety than adult men, few studies have examined gender differences in adolescent perceptions of dentists. Therefore, this cross-sectional study aimed to evaluate the gender differences in adolescents’ perceptions toward dentists by using the Japanese version of the Dental Beliefs Survey (DBS) and the factor structure of the DBS.

Methods

We conducted surveys at schools, and 957 Japanese adolescents (403 girls and 554 boys, aged between 13 and 15 years) participated in this study. To assess their confidence in dentists, participants were asked to complete the self-reported, 15-item Japanese version of the DBS. We performed a Welch’s t-test and a one-way analysis of variance to assess differences in DBS scores by gender and age. Factor analysis (principal components, varimax rotation) was used to assess the scale’s factor structure.

Results

A significant gender difference was observed in the DBS scores (P = 0.018), suggesting that boys exhibit greater negative perceptions toward the behavior of dentists than girls. However, there was no significant difference found among ages. The factor analysis yielded two results: Factor 1, “trust” (seven items); and Factor 2, “lack of control” (five items). Notably, the factor structure differed according to gender. As such, by including only factors with eigenvalues above 1.0, the DBS for girls comprised “trust” (seven items) and “communication” (three items), while that for boys comprised “lack of control” (six items) and “belittlement” (six items).

Conclusions

This study identified two factors of differing strengths pertaining to the confidence of Japanese adolescents in dentists. Gender differences in perceptions toward dentists were observed. Accounting for these differences may improve the effectiveness of strategies to lower dental anxiety and foster positive dental beliefs in young patients.

Effect of Audio-Visual Treatment Information on Hemodynamic Parameters during the Transalveolar Extraction of Mandibular Third Molars: A Randomized Clinical Trial

Objectives:

Anxiety regarding dental procedures is a universal challenge for every patient and the treating dental surgeon. Measurement of heart rate, blood pressure, and oxygen saturation is now commonly accepted by the scientific community as an accurate and objective measurement of the patient's anxiety compared to other subjective assessments. The aim of this study was to assess the influence of educational videos demonstrating transalveolar extraction of mandibular third molars on hemodynamic parameters.

Materials and Methods:

The study was designed as a prospective clinical trial. The modified dental anxiety scale was used to assess the preoperative anxiety of the patient. Participating patients were divided randomly into two groups (verbal and video group). Each patient's hemodynamic parameters such as heart rate, blood pressure, and oxygen saturation were measured in the waiting area, sitting on the dental chair, incision, bone drilling, tooth elevation, suturing, and in the postoperative area. All the analysis was done using the SPSS version 18 software.

Results:

Overall, there were no significant differences between the two groups with respect to hemodynamic parameters. The mean heart rate and blood pressure of patients between both groups were comparatively consistent and did not very much from the onset of procedure to the end. On the other hand, oxygen saturation levels were statistically significantly higher in the video group at the onset of incision and drilling.

Conclusions:

Videos can be interpreted in different ways by patients. Overall, hemodynamic parameters are overall not influenced with videos.

Gagging prevalence and its association with dental fear in 4-12-year-old children in a dental setting

AIM

The aims were to determine the prevalence of gagging in children in the dental setting, detect any association between gagging and dental fear in that setting, and determine if the association varied by type of setting.

DESIGN

A total of 734 children (4-12 years old), seeking dental care either at a University paediatric dental clinic (UC) or at a private paediatric practice (PP), filled out the Greek version of the Gagging Assessment Scale (GAS, subjective assessment) and the Greek version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). The shorter form of the Gagging Problem Assessment-dentist part for children (GPA-de-c/SF, dentist's objective measurement) was used to assess their gag reflex.

RESULTS

A total of 209 children (28.47%) gagged according to the GPA-de-c/SF. There was no significant difference in gagging between UC and PP children. Children rated as gaggers on the GPA-de-c/SF reported significantly higher GAS and CFSS-DS scores (U = 33 629.000; P < 0.001, U = 31 955.500, P < 0.001, respectively). Also, there was a significant association between GAS and CFSS-DS (rho = 0.307, P < 0.001).

CONCLUSIONS

In the dental setting, there were significant relationships between dental fear, the dentist's objective measurement of gagging severity, and the child's subjective gagging assessment.

Cross-Cultural adaption, validity and reliability of a Hindi version of the Corah's Dental Anxiety Scale

Background: An appropriate scale to assess the dental anxiety of Hindi speaking population is lacking. This study, therefore, aims to evaluate the psychometric properties of Hindi version of one of the oldest dental anxiety scale, Corah’s Dental Anxiety Scale (CDAS) in Hindi speaking Indian adults.

Methods: A total of 348 subjects from the outpatient department of a dental hospital in India participated in this cross-sectional study. The scale was cross-culturally adapted by forward and backward translation, committee review and pretesting method. The construct validity of the translated scale was explored with exploratory factor analysis. The correlation of the Hindi version of CDAS with visual analogue scale (VAS) was used to measure the convergent validity. Reliability was assessed through calculations of Cronbach’s alpha and intra class correlation 48 forms were completed for test-retest.

Results: Prevalence of dental anxiety in the sample within the age range of 18-80 years was 85.63% [95% CI: 0.815-0.891]. The response rate was 100 %. Kaiser-Meyer-Olkin (KMO) test value was 0.776. After factor analysis, a single factor (dental anxiety) was obtained with 4 items.The single factor model explained 61% variance. Pearson correlation coefficient between CDASand VAS was 0.494. Test-retest showed the Cronbach’s alpha value of 0.814. The test-retest intraclass correlation coefficient of the total CDAS score was 0.881 [95% CI: 0.318-0.554].

Conclusion: Hindi version of CDAS is a valid and reliable scale to assess dental anxiety in Hindi speaking population. Convergent validity is well recognized but discriminant validity is limited and requires further study.

Validity and reliability of an Arabic version of the state-trait anxiety inventory in a Saudi dental setting

Objectives:

To test the psychometric properties of an adapted Arabic version of the state trait anxiety-form Y (STAI-Y) in Saudi adult dental patients.

Methods:

In this cross-sectional study, the published Arabic version of the STAI-Y was evaluated by 2 experienced bilingual professionals for its compatibility with Saudi culture and revised prior to testing. Three hundred and eighty-seven patients attending dental clinics for treatment at the Faculty of Dentistry Hospital, King Abdullah University, Jeddah, Kingdom of Saudi Arabia, participated in the study. The Arabic version of the modified dental anxiety scale (MDAS) and visual analogue scale (VAS) ratings of anxiety were used to assess the concurrent criterion validity.

Results:

The Arabic version of the STAI-Y had high internal consistency reliability (Cronbach’s alpha: 0.989) for state and trait subscales. Factor analysis indicated unidimensionality of the scale. Correlations between STAI-Y scores and both MDAS and VAS scores indicated strong concurrent criterion validity. Discriminant validity was supported by the findings that higher anxiety levels were present among females as opposed to males, younger individuals as compared to older individuals, and patients who do not visit the dentist unless they have a need as opposed to more frequent visitors to the dental office.

Conclusion:

The Arabic version of the STAI-Y has an adequate internal consistency reliability, generally similar to that reported in the international literature, suggesting it is appropriate for assessing dental anxiety in Arabic speaking populations.

Prevalence of Dental Anxiety among Dental Patients in Saudi Arabia

OBJECTIVE

Anxiety towards dental procedures are common difficulties that may be experienced by dental patients all over the world. This study focused on evaluating the dental anxiety frequency and its relationship with age, gender, educational level, and past dental visits among patients attending the outpatient clinics of College of Dentistry, Al Jouf University, Saudi Arabia.

MATERIAL AND METHODS

A total of 221 patients, aged 21-50 years were selected for the study. A questionnaire comprising the Modified Dental Anxiety Scale (MDAS) was used to measure the level of dental anxiety. Data was analyzed using SPSS version 20.

RESULTS

The mean anxiety score of the 221 patients was 11.39 (SD ± 2.7). Independent t-test showed a significant variation between the age groups with regards to their mean overall anxiety score (P < 0.05), which reduced with increasing age. A significant difference was found by independent t-test in the mean total score between male and female groups and regarding previous dental visit (P < 0.05). Regarding education level, there was no significant difference between the groups (P > 0.05).

CONCLUSION

Younger patients, female, and patients with previous unpleasant dental experience were associated with increased MDAS score.

CLINICAL SIGNIFICANCE

The present study was done for better patient management and proper treatment plan development for dentally anxious patients.

Translation and Validation of Modified Dental Anxiety Scale: The Nepali Version

Introduction. For proper management of anxious dental patients it is imperative to assess their levels of dental anxiety before treatment. Modified Dental Anxiety Scale (MDAS) is the most commonly used questionnaire to assess dental anxiety. But a Nepali version of MDAS is still lacking. Hence, the objective of this study was to develop a reliable and valid Nepali version of MDAS. Materials and Methods. The English version of the MDAS was translated into Nepali following a forward and backward translation process. Following pretesting and cognitive interviewing a final version of Nepali questionnaire was obtained. One hundred and fifty patients attending Department of Orthodontics completed the Nepali version of MDAS questionnaire at their convenience. Also, patients were asked to rate their overall anxiety on a 100 mm visual analog scale (VAS). A test-retest of the questionnaire was performed with 30 patients after 2 weeks. Results. Cronbach's alpha value of the Nepali version of MDAS was 0.775. The Intraclass Correlation Coefficient between test and retest was 0.872. Spearman's correlation coefficient between the total MDAS score and VAS score was 0.838. Conclusion. The translated Nepali version of MDAS is a reliable and valid instrument to measure the dental anxiety of Nepali patients.

Psychometric assessment of anxiety with the Modified Dental Anxiety Scale among central Indian adults seeking oral health care to a dental school

BACKGROUND

Anxiety toward dental treatment can cause people to delay or avoid seeking oral health care despite being in need of treatment. Therefore, recognizing such anxious patients and their appropriate management plays important aspects in clinical practice.

AIM

The aim of this study was to investigate the level of dental anxiety (DA), factors affecting it, and anxiety toward dental extraction among adults seeking dental care to a dental school in Central India.

MATERIALS AND METHODS

The study sample consisted of 1360 consecutive patients aged 18-70 years. Participants completed a questionnaire while in the waiting room, which included the Modified Dental Anxiety Scale (MDAS) to assess the level of DA. An additional item was included which asked participants to rate the anxiety felt on having a tooth extracted.

RESULTS

Among the study group, 65.1% were men and 34.9% were women. Based on the MDAS score, 41.8% of the participants were identified to be less anxious, 53.2% were moderately or extremely anxious, and 5% were suffering from dental phobia. Female participants and younger patients were more anxious (P = 0.0008). Patients who were anxious had postponed their dental visit (P = 0.0008). Participants who had negative dental experience were more anxious (P = 0.03). Nearly, 83% reported anxiety toward extraction procedure. A significant association was observed between anxiety toward dental extraction and the patients' gender (P = 0.03), age (P = 0.0007), education level (P = 0.03), employment status (P = 0.0006), income (P = 0.0007), self-perceived oral health status (P = 0.03), and their history of visit to dentist (P = 0.02).

CONCLUSION

Majority of patients in this population revealed high levels of DA. Factors such as age, gender, education level, occupation, financial stability, and previous bad dental experience influence DA to various levels. Extraction followed by injection of local anesthetics and drilling of tooth provoked more anxiety.

Cross-Cultural Adaptation of Kannada Version of Modified Dental Anxiety Scale Among an Adult Indian Population

BACKGROUND

Dental anxiety is one of the most common barriers in seeking dental care. In order to overcome this barrier dentist need to screen patients to successfully help in treatment. A scale is thus needed to measure dental anxiety which is socially & culturally acceptable.

AIM

This study aimed to assess the Cross cultural adaptation and validity of the Kannada translation of the Modified Dental Anxiety Scale (MDAS-K).

MATERIALS AND METHODS

A test-retest was conducted on 30 patients visiting a dental institution to assess the reliability of MDAS- K. A cross-sectional survey of 301 patients was conducted in different departments at a dental institution to test the psychometric properties of MDAS-K. The assessment tool consisted of a proforma containing socio-demographic, non socio- demographic variables, MDAS-K and Visual analogue scale (VAS).

STATISTICAL ANALYSIS

Reliability was assessed using Cronbach's alpha, inter-item Spearman's correlation. Independent t-test, ANOVA and post hoc Bonferroni were used to analyse dental anxiety in the psychometric constructs.

RESULTS

The internal consistency of MDAS-K was good with Cronbach's alpha of 0.83. The test-retest reliability for MDAS K had a good correlation of 0.901. The psychometric variables established the construct validity of MDAS-K.MDAS-K also showed good convergent validity with VAS score. The anxiety levels differed in patients visiting different dental departments.

CONCLUSION

The high reliability and validity of the MDAS-K supports its cross cultural adaptation and indicates that it can be a valuable tool for dental practioners in quantifying anxiety among patients and provide quality dental care.

Dental anxiety among adults: an epidemiological study in South India

Background:

Dental anxiety is a major barrier for dental care utilization. Hence, identifying anxious individuals and their appropriate management becomes crucial in clinical practice.

Aim:

The study aims to assess dental anxiety, factors influencing dental anxiety, and anxiety towards tooth extraction procedure among patients attending a dental hospital in India.

Materials and Methods:

The study sample consisted of 1,148 consecutive patients aged 18-70 years. The assessment tools consisted of a consent form, history form, a questionnaire form containing the Modified Dental Anxiety Scale (MDAS) which was used to assess the level of dental anxiety, and an additional question on anxiety towards dental extraction procedure.

Results:

Among the study group, 63.7% were men and 36.3% were women. Based on the MDAS score, 45.2% of the participants were identified to be less anxious, 51.8% were moderately or extremely anxious, and 3% were suffering from dental phobia. Mean MDAS total score was 10.4 (standard deviation (SD) = 3.91). Female participants and younger subjects were more anxious (P < 0.001). Subjects who were anxious had postponed their dental visit (P < 0.001). Participants who had negative dental experience were more anxious (P < 0.05). Notably, 82.6% reported anxiety towards extraction procedure. Significant association was seen between anxiety towards extraction procedure and the respondents gender (P < 0.05), age (P < 0.001), education level (P < 0.05), employment status (P < 0.001), income (P < 0.001), self-perceived oral health status (P < 0.05), and their history of visit to dentist (P < 0.05).

Conclusion:

Significant percentage of population was suffering from dental anxiety in this study population. A plethora of factors like age, gender, education level, occupation, financial stability, and previous bad dental experience influences dental anxiety to various levels. Extraction followed by drilling of tooth and receiving local anesthetic injection provoked more anxiety.

Prevalence of dental anxiety and its relation to age and gender in coastal Andhra (Visakhapatnam) population, India

Background:

Dental fear, anxiety and phobia have consistently been reported as widespread problems that persist despite the technological advances that have made dentistry less painful and less uncomfortable. The aim of this study was to assess the prevalence of dental anxiety (DA) and its relation to age and sex among Coastal Andhra (Visakhapatnam) population.

Materials and Methods:

A randomized controlled study was designed among 340 individuals at GITAM Dental College and Hospital, Visakhapatnam. The sample for the study consisted of 180 female and 160 male subjects between 15 and 65 years of age; all were supplied with two questionnaires (Corah DA scale [CDAS] and Clarke and Rustvold dental concerns assessment scale describing anxiety provoking stimuli. The Mann-Whitney U-test and the Kruskal-Wallis test were applied (significance level P < 0.05). The correlations between the two questionnaires were calculated using the Spearman's rank correlation coefficient.

Results:

Two questionnaires were collected from all 340 individuals and the Indian translation of both instruments was found to be internally reliable with a Cronbach's alpha of 0.093. Overall prevalence of DA was high (77.4%) but severe (22.6%) anxiety (phobia) was low. Kruskal-Wallis test showed a significant relation between age and DA. The mean CDAS scores were high in 25-35 (11.08) and low in 55-65 (9.45) year age groups. Mann-Whitney U test showed significant relation between sex and DA. Mean CDAS score levels were significantly higher in females (10.88) than in males (9.96) (P < 0.0001).

Conclusion:

Patients anxious about dental procedures are often more difficult to treat. If Dentists become aware about the level of DA among their patients, they can anticipate patient's behavior and can be prepared to take behavioral/pharmacological measures to reduce anxiety levels.

Validation of the Malay version of the Modified Dental Anxiety Scale and the prevalence of dental anxiety in a Malaysian population

AIM

The aims of the present study were to evaluate the reliability and validity of the Malay version of the Modified Dental Anxiety Scale (MDAS), and to determine the prevalence of dental anxiety and associated factors in a Malaysian population.

METHODS

A Malay-language questionnaire with questions to elicit demographic and dental care-related information, and the Malay version of the MDAS, were administered to 455 patients at the dental outpatient clinics of the Hospital Universiti Sains Malaysia. Factor analysis and internal consistency statistics were generated. A test-retest of the questionnaire was performed with 30 participants.

RESULTS

Cronbach's alpha was 0.854, indicating good internal consistency. Factor analysis yielded results showing good validity. Approximately 3.5% of the participants expressed the highest levels of anxiety. Dental anxiety was significantly higher among females than males. Age correlated inversely with dental anxiety. Individuals seeking dental care only if a problem appeared had significantly more anxiety than regular attendees. Patients who postponed treatment because of fear had significantly higher anxiety levels than those who delayed treatment for other reasons. Past adverse dental experience exacerbated dental anxiety.

CONCLUSION

The Malay version of the MDAS had good reliability and validity. Anxiety levels found in the Malaysians studied were comparable to participants from other countries.

Validation of the Modified Dental Anxiety Scale (MDAS) in an Italian Sample and Invariance Across Gender and Mode of Administration

About 7–12% of individuals experience high dental anxiety and it represents a barrier to dental care. The Modified Dental Anxiety Scale (MDAS) is a brief measure of dental anxiety which is widely used in clinical practice as well as in research. The principal aims of this study were to create and validate an Italian version of the MDAS and to determine whether its validity was influenced by gender and different methods of data collection (on paper or electronically). A secondary objective was to collect further evidence of criterion validity and reliability of the scale. A self-report battery of standardized psychological measures, including the Italian MDAS and other measures, was completed on paper by 126 patients attending a dental clinic and electronically by 108 respondents plus 40 dentists. Fifty-nine percent of all subjects were female. Confirmatory factor analyses supported a two-factor model for the Italian MDAS and measurement invariance across gender and method of administration. Both internal consistency and 4-week test-retest estimates of reliability were good. The Italian MDAS was shown to be differentially correlated in expected ways with other constructs. Women showed higher dental anxiety than men and online respondents reported higher dental anxiety than dental patients.

Reliability and validity of the Tamil version of Modified Dental Anxiety Scale

The aim of this study was to test the reliability and validity of the Tamil version of the Modified Dental Anxiety Scale (MDAS). One hundred and forty-six patients attending the Outpatient Department of SRM Dental College, Chennai, India consented to participate in the study. The assessment tools consisted of a history form, Tamil version of the MDAS questionnaire and a form for Visual Analogue Scale (VAS). The Tamil version of MDAS had a good internal consistency of 0.839. The mean total score decreased with age. Females were more anxious than males (10.16 and 9.43, respectively). Uneducated, unemployed and low income subjects were more anxious than their counterparts who were educated, employed and from a higher income group. Persons who perceived their oral health as poor were more anxious. Independent t-test showed a highly significant difference in the mean total score of the respondents who had postponed their dental visit due to anxiety (t-test 6.494, P < 0.001). VAS and MDAS scores showed a highly significant correlation (r = 0.827, P < 0.001). This supported the convergent validity of MDAS. The Tamil version of MDAS showed acceptable psychometric properties.

Dental neglect and adverse birth outcomes: a validation and observational study

OBJECTIVES

The objectives of this study were to validate the Indian translation of the Dental Neglect Scale (DNS) among a sample of parturient Indian women and to investigate dental neglect as a possible risk indicator in adverse birth outcomes.

SUBJECTS AND METHODS

Three hundred and sixteen parturient women were administered the DNS and the Modified Dental Beliefs Scale (MDBS) and were also clinically examined for oral health status. Information regarding socio-economic status, weeks of gestation and birth weight was also collected. A gestation period of less than 37 weeks was considered as preterm and a birth weight of less than 2500 gm as 'low birth weight'.

RESULTS

The Indian version of the DNS was found to be reliable (Cronbach's Alpha = 0.72) and valid for assessing dental neglect among the women. Factor analysis of the DNS revealed a two-factor structure accounting for 56% variance. Dental neglect was higher among those with poorer oral health status, lower socio-economic and educational status. Multinomial logistic regression showed high dental neglect and negative dental beliefs and not poor oral health, as significant risk indicators for occurrence of adverse birth outcomes.

CONCLUSION

The finding of an association of adverse birth outcomes with dental neglect and beliefs, but not with poor oral health could be due to the influence of other more important general factors which had a direct bearing on birth outcomes. There is a need for further research to assess the role of behavioural factors like dental neglect as risk indicators for adverse birth outcomes.

Ansiedade frente ao tratamento odontológico: prevalência e fatores predictores em brasileiros

Diante do impacto negativo que a ansiedade exerce sobre o atendimento odontológico, buscou-se conhecer sua prevalência e seus fatores predictores frente esse tratamento em brasileiros. Foi realizado um estudo de corte transversal, utilizando-se a escala de ansiedade de Corah para avaliar 3000 pacientes. Os resultados demonstram que 2 em cada 8 brasileiros avaliados apresentaram moderada ou severa ansiedade frente ao atendimento odontológico, verificando-se que a probabilidade de um paciente da população da qual a amostra foi extraída apresentar ansiedade é mais elevada se: for mulher (p = 0,007), da faixa etária superior a 20 anos (p = 0,006), se não possuir acesso a internet e/ou jornais (p = 0,016), se tiver baixa frequência de higiene oral (p = 0,001), se a visita dental for motivada por busca de tratamento curativo, por dor ou outro problema, ao invés de um check-up (p = 0,047), e experiência de odontalgia (p<0,001). O medo e a ansiedade a fatores odontológicos existem de fato na população brasileira e as conclusões do estudo sugerem que, além da falta de recursos econômicos, o descaso com a saúde bucal, o gênero e a idade podem aumentar o grau de ansiedade.

Assessment of dental fear and anxiety levels in eating disorder patients undergoing minor oral surgery

PURPOSE

The aim of the present study was to evaluate the levels of dental fear and anxiety in women with eating disorders (EDs) scheduled for oral surgery.

PATIENTS AND METHODS

A total of 61 patients with EDs, an identical number of age-, gender-, and education-matched healthy controls, and 2 consecutive, randomly selected, clinical and nonclinical samples each consisting of 220 female subjects were included in the present study. The participants completed the demographic and clinical forms, as well as the modified dental anxiety scale (MDAS) and dental fear survey (DFS) before the surgical procedure.

RESULTS

The mean scores of the MDAS and DFS for the study population correlated negatively with age and positively with a previous unpleasant experience related to dentistry (P < .01 for both). Patients with EDs had significantly greater mean scores on the MDAS than the clinical and nonclinical groups (P < .05 for both). Their mean scores on the DFS were significantly greater than those for the nonclinical participants (P < .05). A significant difference was found in the DFS subscale "fear of specific situations and stimuli" compared with the healthy matched controls and clinical and nonclinical subjects (P < .05 for all).

CONCLUSION

The results of our study have shown that patients with EDs can be more sensitive to the auditory, visual, and contact stimuli of the oral surgery procedures under local anesthesia. They also had greater levels of dental fear and anxiety than routine clinical patients and randomly selected subjects from a nonclinical environment.

The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London

OBJECTIVE

To investigate whether the relationship between dental anxiety and referral for treatment under sedation is explained by attendance patterns and oral health.

METHODS

Structural Equation Modeling was used on the covariance matrix of the covariates to test hypothesized inter-relationships. Subsequently, we modeled the probability of referral for treatment under sedation with a multiple logistic regression taking into account inter-relationships between the independent variables.

RESULTS

A direct significant association of referral with dental anxiety and attendance patterns was detected, but not with oral health status. However, oral health and anxiety were highly correlated. Also signaled were correlations between age and education and between gender and bad past experience.

CONCLUSION

Referral for treatment under sedation appears to be motivated by both fear and irregular patterns of attendance. Coupled with behavioral treatments to address dental fear and attendance, sedation can be an important part of comprehensive care where curative treatments are long or unpleasant for patients.

Additional psychometric data for the Spanish Modified Dental Anxiety Scale, and psychometric data for a Spanish version of the Revised Dental Beliefs Survey

Background

Hispanics comprise the largest ethnic minority group in the United States. Previous work with the Spanish Modified Dental Anxiety Scale (MDAS) yielded good validity, but lower test-retest reliability. We report the performance of the Spanish MDAS in a new sample, as well as the performance of the Spanish Revised Dental Beliefs Survey (R-DBS).

Methods

One hundred sixty two Spanish-speaking adults attending Spanish-language church services or an Hispanic cultural festival completed questionnaires containing the Spanish MDAS, Spanish R-DBS, and dental attendance questions, and underwent a brief oral examination. Church attendees completed the questionnaire a second time, for test-retest purposes.

Results

The Spanish MDAS and R-DBS were completed by 156 and 136 adults, respectively. The test-retest reliability of the Spanish MDAS was 0.83 (95% CI = 0.60-0.92). The internal reliability of the Spanish R-DBS was 0.96 (95% CI = 0.94-0.97), and the test-retest reliability was 0.86 (95% CI = 0.64-0.94). The two measures were significantly correlated (Spearman's rho = 0.38, p < 0.001). Participants who do not currently go to a dentist had significantly higher MDAS scores (t = 3.40, df = 106, p = 0.003) as well as significantly higher R-DBS scores (t = 2.21, df = 131, p = 0.029). Participants whose most recent dental visit was for pain or a problem, rather than for a check-up, scored significantly higher on both the MDAS (t = 3.00, df = 106, p = 0.003) and the R-DBS (t = 2.85, df = 92, p = 0.005). Those with high dental fear (MDAS score 19 or greater) were significantly more likely to have severe caries (Chi square = 6.644, df = 2, p = 0.036). Higher scores on the R-DBS were significantly related to having more missing teeth (Spearman's rho = 0.23, p = 0.009).

Conclusion

In this sample, the test-retest reliability of the Spanish MDAS was higher. The significant relationships between dental attendance and questionnaire scores, as well as the difference in caries severity seen in those with high fear, add to the evidence of this scale's construct validity in Hispanic samples. Our results also provide evidence for the internal and test-retest reliabilities, as well as the construct validity, of the Spanish R-DBS.

Does dental anxiety influence oral health-related quality of life? Observations from a cross-sectional study among adults in Udaipur district, India

We investigated the effect of dental anxiety and dental visiting habits, as well as various socio-demographic variables, on oral health-related quality of life (OHQoL) among subjects aged 15-54 years living in Udaipur district, India. The total sample size was 1235 individuals and a stratified cluster sampling procedure was employed to collect the representative sample. Dental anxiety and oral health-related quality of life were assessed using the Corah Dental anxiety scale and the OHQoL-UK(W) questionnaire, respectively. The majority of the female and older individuals showed higher dental anxiety than their male and younger counterparts. Stepwise linear regression analysis revealed that the best predictors of dental anxiety were, in descending order, occupation, gender and education, which provided a variance of 10.3%. Females were more likely to have poor OHQoL than males. Dental anxiety had a significant influence on OHQoL, people with high dental anxiety being 2.34 times more likely to present poor OHQoL than those having low anxiety. Furthermore, it was found that those who never visited a dentist had an odds ratio of 1.62 for poor OHQoL relative to those who had visited a dentist within the last 12 months. Dental anxiety differed significantly with age and dental visiting practices, and had a significant impact on oral health-related quality of life after controlling for other variables.