Dental anxiety among middle-aged and elderly women in Sweden. A study of oral state, utilisation of dental services and concomitant factors

Dental anxiety and potentially traumatic events: a cross-sectional study based on the Tromsø Study-Tromsø 7

OBJECTIVE

The objectives of the study were to describe the prevalence of dental anxiety and the possible associations between dental anxiety and potentially traumatic events in an adult population.

METHOD

The study is based on cross-sectional questionnaire data from the 7th wave of the Tromsø Study, a study of the adult general population in the municipality of Tromsø carried out in 2015-2016. The Modified Dental Anxiety Scale was used to measure dental anxiety across potentially traumatic events, oral health, dental attendance (avoidance) and current mental health symptoms (Hopkins Symptom Checklist). Individuals with high and low dental anxiety scores were compared to investigate differences in the distribution of potentially traumatic events, current mental health symptoms, avoidance, sex and oral health, and hierarchical multivariable regression was used to study the influence of traumatic events on dental anxiety.

RESULTS

High dental anxiety was reported by 2.9% of the sample and was most prevalent among females and in the youngest age groups. Individuals with high dental anxiety reported more current mental health symptoms, and they were more likely to report poorer oral health and more irregular dental visits compared to individuals with no or lower dental anxiety scores. Concerning traumatic events, the reporting of painful or frightening dental treatment showed the biggest difference between those with high dental anxiety and low dental anxiety scores (a moderate effect). The hierarchical regression model indicated that reporting sexual abuse, traumatic medical treatment in hospital and childhood neglect significantly predicted dental anxiety in the step they were entered in, but only sexual abuse remained a significant individual contributor after controlling for current mental health symptoms.

CONCLUSIONS

The prevalence of high dental anxiety was lower than expected (2.9%), but dentally anxious individuals expressed a high burden of mental health symptoms, poor oral health and the avoidance of dental care. The regression analysis indicated that experiences with sexual abuse could affect dental anxiety levels in the absence of generalised symptoms of anxiety and depression.

Dental pain and oral health-related quality of life in individuals with severe dental anxiety

OBJECTIVES

To analyze the prevalence and level of dental pain among adult individuals with severe dental anxiety (DA), and the association between dental pain and oral health-related quality of life (OHRQoL).

METHODS

The study was based on 170 adult individuals with DA referred to a specialized DA clinic. All patients answered a questionnaire including questions on DA (DAS, DFS), OHRQoL (OIDP) and dental pain. An adapted clinical examination and a panoramic radiograph revealed the present oral status.

RESULTS

The prevalence of dental pain was high (77.6%) and among those reporting pain the intensity was high (49.0-61.0 on a VAS). One or more problems during the last 6 months with the mouth or teeth affecting the individual's daily activities were reported in 85.3% of the participants. Individuals who reported dental pain had lower OHRQoL compared with those who did not report dental pain (p < .001). Dental pain and number of decayed teeth were associated with the probability of poor OHRQoL (OR = 8.2, p < .001, OR = 3.8, p = .008).

CONCLUSION

This study revealed a high prevalence and a high level of dental pain among adult individuals with severe DA. Having dental pain was associated with poor OHRQoL.

Dental coping strategies, general anxiety, and depression among adult patients with dental anxiety but with different dental-attendance patterns

The aim of the present study was to investigate dental coping strategies, general anxiety, and depression in relation to regularity of dental treatment among persons with either regular dental care or phobic avoidance, whilst controlling for sociodemographic factors. Psychometric questionnaires on dental anxiety, dental coping strategies, general anxiety, and depression were delivered to 263 adult patients with dental phobic avoidance behavior who were seeking help from a specialized dental fear clinic and to 141 adult patients with dental anxiety who were receiving regular dental care from various public dental clinics. The results showed that the levels of dental and general anxiety and of depression were significantly higher among irregular attendees compared with regular attendees. Irregular attendees admitted fewer adaptive coping strategies. Predictive of irregular dental care were gender, dental anxiety, general anxiety, and the nonuse of the coping strategy 'optimism'. This study further confirms earlier preliminary results that the use of optimistic thinking is predictive for regular dental attendance habits and that male gender is a risk factor for irregular attendance. Moreover, this study adds that a high level of general anxiety indicates a higher risk for irregular dental care.

Adaptive coping strategies among adults with dental fear. Further development of a new version of the Dental Coping Strategy Questionnaire

OBJECTIVE

The aim of this study was to further develop and investigate a newly constructed 15-item questionnaire on strategies for coping with dental treatment, used by fearful adult patients undergoing regular dental care and those with phobic avoidance.

MATERIALS AND METHODS

The dental coping strategy questionnaire (DCSQ-15) was distributed to 77 individuals with dental phobic avoidance and 94 fearful patients undergoing regular dental care. Previous analyses of a 20-item coping questionnaire (DCSQ-20) revealed that 2 of 4 identified factors predicted regularity or phobic avoidance of dental care. However, one of these factors was considered related to catastrophizing thoughts and not to coping strategies and it was therefore removed in the present study.

RESULTS

The reduced 15-item questionnaire was analyzed to identify its factor structure and a 5-factor solution was found. The five factors were labeled (i) 'self-efficacy', (ii) 'self-distraction', (iii) 'distancing', (iv) 'praying' and (v) 'optimism'. The factors of 'praying' and 'optimism' correlated significantly with dental anxiety and were assessed significantly higher and lower respectively, among individuals with phobic avoidance. A logistic regression analysis revealed that 'optimism', together with gender and dental anxiety, was predictive of the regularity or phobic avoidance of dental care.

Factors of importance to maintaining regular dental care after a behavioural intervention for adults with dental fear: a qualitative study

OBJECTIVE

Dental phobia is prevalent in the general population and can be successfully treated through cognitive behavioural therapy, which results in patients being able to cope with dental treatments. The aim of this study was to increase the understanding of factors of importance for maintaining regular dental care after completion of a cognitive behavioural therapy programme.

MATERIAL AND METHODS

A qualitative study design was used. Fourteen individuals who had successfully completed the programme and had thereafter been referred to a general dental practitioner were interviewed. An interview guide with open-ended questions was used. The interviews were tape-recorded and transcribed verbatim. The texts were analysed using descriptive and qualitative content analysis (Grounded Theory).

RESULTS

The manifest analysis identified four content areas: experience of dental care, content of the behavioural therapy programme, perception of therapy and impact on quality of life. The latent analysis identified influence on quality of life, security, activity and barriers to dental care as categories. Although all informants had successfully completed the dental fear treatment programme, only a few stated that they had an uncomplicated relation to dental care afterwards. Barriers to dental care were lack of money and fear. A sense of security was conclusive to coping with dental care, and a respectful approach on the part of the dental care personnel was essential to development of this sense.

CONCLUSIONS

Confidence in one's own ability to cope with dental care and the right to guide the treatment were important. Thus the theme in the present study was self-efficacy and respectful dental care personnel.

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.

Dental caries risk indicators among Australian Aboriginal young adults

OBJECTIVES

To determine dental caries risk indicators among a birth cohort of Australian Aboriginal young adults (n=442).

METHODS

Data were from the Aboriginal Birth Cohort study, a prospective longitudinal investigation of Aboriginal individuals born 1987-1990 at an Australian regional hospital. Models representing demographic, socioeconomic, behavioural, dental service utilization and clinical oral health variables were tested using multivariate regression.

RESULTS

The percent DT>0 was 72.9 (95% CI 68.7-77.1), mean DT was 4.19 (95% CI 3.8-4.6), percent DMFT>0 was 77.4 (95% CI 73.5-81.3) and mean DMFT was 4.84 (95% CI 4.4-5.3). After controlling for other covariates, risk indicators for percent DT>0 included soft drink consumption every day or a few times a week (PR 1.25, 95% CI 1.08-1.45), not consuming milk every day or a few times a week (PR 1.16, 95% CI 1.04-1.30) and sweet consumption every day or a few times a week (PR 1.18, 95% CI 1.04-1.33). Risk indicators for mean DT included sweet consumption every day or a few times a week (B=1.14, 95% CI 0.27-2.02), nonownership of a toothbrush (B=0.91, 95% CI 0.10-1.87) and presence of plaque (B=2.46, 95% CI 0.96-3.96). Those with 4 +  occupants in their house the previous night had 1.2 times the prevalence of having DMFT>0 than their counterparts with less household occupants (95% CI 1.01-1.49). Percent DMFT>0 was also associated with consumption of soft drink every day or a few times a week (PR 1.18, 95% CI 1.04-1.34) and consumption of sweets every day or a few times a week (PR 1.23, 95% CI 1.10-1.37). Mean DMFT was higher among those who consumed sweets every day or a few times a week (B = 0.13, 95% CI 0.05-0.22) and who had dental anxiety (B=0.10, 95% CI 0.01-0.19).

CONCLUSIONS

In an Australian Aboriginal young adult cohort, risk indicators for dental caries included social determinants such as household size, dietary behaviours such as regular consumption of soft drink and sweets, dental behaviour such as nonownership of a toothbrush and dental anxiety.

Effect of fear on dental utilization behaviors and oral health outcome

OBJECTIVES

This paper assesses the effect of fear on a number of dental utilization behaviors and oral heath outcome in a sample of adult Floridians.

METHODS

A telephone survey was conducted in 2004 among 504 adult Floridians. Data collected included sociodemographic factors, specific fear of dental pain (FDP), global FDP, global dental fear, three measures of dental utilization behaviors, and one measure of oral health outcome. Chi-squared tests and logistic regression analyses were conducted to quantify the individual and multivariate associations between fear factors and four behavior and outcome measures.

RESULTS

Global FDP was significantly associated with putting off making a dental appointment and approach to dental treatment. Global dental fear showed an independent negative impact on all four behavior and outcome measures; reports regarding specific fear of painful dental events were not significantly associated with four behavior and outcome measures.

CONCLUSIONS

Our findings suggest that: (i) dental fear and FDP have independent negative effects on dental utilization behaviors and oral health outcome after controlling for other sociodemographic and general health factors; and (ii) global dental fear encompasses broader components than FDP.

Association between dental fear and dental attendance among adults in Finland

OBJECTIVE

Our aim was to evaluate the association between dental attendance and dental fear while considering the simultaneous effects of perceived oral health and treatment need, satisfaction with oral health services, age, gender, marital status, and attained level of education.

MATERIAL AND METHODS

The two-stage stratified cluster sample (n=8028) represented Finnish adults aged 30 years and older. The response rate to this nationwide sample was 88%. Dental fear was measured with the question: "How afraid are you of visiting a dentist?" Multiple logistic regression analyses were used to determine the association between dental fear and dental attendance, including the following independent variables: perceived oral health, perceived treatment need, satisfaction with oral health services, age, gender, marital status, and attained level of education.

RESULTS

Among all ages, except 30 to 34-year-olds, irregular attenders were more likely to be very afraid of visiting a dentist than regular attenders were. The association was stronger the older the age group. Only age modified the association between dental fear and attendance. Irregular dental attendance can be attributed to high dental fear (etiologic fraction among exposed) in 41% of cases.

CONCLUSION

Reducing dental fear would increase the number of regular attenders, especially among older age groups. Individuals for whom oral health services have been provided regularly since childhood seem to continue to use these services regularly despite high dental fear.

Dental fear among population aged 30 years and older in Finland

OBJECTIVE

The aim of the study was to examine how the percentage of subjects reporting dental fear varied in accordance with age, gender, level of educational attainment, and marital status in a nationally representative sample of the adult population in Finland.

MATERIAL AND METHODS

The two-stage stratified cluster sample (n=8028) represented the population aged 30 years or older living in Finland. Of this nationwide sample, 88% participated. Dental fear was measured with the question: "How afraid are you of visiting a dentist?" The reply alternatives were: "Not at all", "Somewhat", and "Very much". Age-specific multiple logistic regression analyses were used to explore the associations between dental fear and age, gender, marital status, and level of educational attainment.

RESULTS

Overall prevalence of being somewhat or very afraid of visiting a dentist among adults in Finland was high (37%), particularly among 30 to 34-year-olds (47%). Among men and women of different ages, 5% to 19% were very afraid and 16% to 59% at least somewhat afraid of visiting a dentist. Female gender was the best determinant of dental fear. Those with higher educational attainment were about half as likely to be very much afraid of dentistry compared to those with secondary educational attainment. Among the youngest age group, non-singles were more likely to report being very much afraid of dentistry than single subjects.

CONCLUSIONS

The fairly high prevalence of reported dental fear among adults, especially in the youngest age group, presents a challenge to dental personnel in Finland.

Oral sedation: a primer on anxiolysis for the adult patient

The use of sedatives has established efficacy and safety for managing anxiety regarding dental treatment. This article will provide essential information regarding the pharmacology and therapeutic principles that govern the appropriate use of orally administered sedatives to provide mild sedation (anxiolysis). Dosages and protocols are intended for this purpose, not for providing moderate or deeper sedation levels.

Balancing efficacy and safety in the use of oral sedation in dental outpatients

BACKGROUND

Concerns about the safety of pediatric oral sedation and the incremental use of triazolam in adults prompted a workshop cosponsored by several professional organizations.

OVERVIEW

There is a strong need and demand for adult and pediatric sedation services. Using oral medication to achieve anxiolysis in adults appears to have a wide margin of safety. Mortality and serious morbidity, however, have been reported with oral conscious sedation, especially in young children. Most serious adverse events are related to potentially avoidable respiratory complications.

CONCLUSIONS

Clinical trials are needed to evaluate oral sedative drugs and combinations, as well as to develop discharge criteria with objective quantifiable measures of home readiness. Courses devoted to airway management should be developed for dentists who provide conscious sedation services. State regulation of enteral administration of sedatives to achieve conscious sedation is needed to ensure safety.

PRACTICE IMPLICATIONS

Safety in outpatient sedation is of paramount concern, with enteral administration of benzodiazepines appearing safe but poorly documented in the office setting. Conscious sedation by the enteral route, including incremental triazolam, necessitates careful patient evaluation, monitoring, documentation, facilities, equipment and personnel as described in American Dental Association and American Academy of Pediatric Dentistry guidelines.

Short-term antidepressant treatment of comorbid dental anxiety in patients with panic disorder

OBJECTIVES

The aims of this study were to determine the frequency of dental anxiety (DA) and dental phobia (DP) in panic disorder, and to follow the changes in DA levels during antidepressant treatment of panic disorder.

METHODS

Fifty-three controls and 102 panic disorder patients were assessed using the Structured Clinical Interview (SCID), the Panic-Agoraphobia Scale (PAS), and the Corah Dental Anxiety Scale (DAS). Oral health status was defined by the number of decayed, missing, and filled teeth (DMFT) index. The patients were classified into three groups: (1) those without dental anxiety (WDA), (2) those with dental anxiety (DA), and (3) those with dental phobia (DP). All patients were treated with antidepressants for 3 months and the response rates were assessed.

RESULTS

At baseline, DAS was significantly higher in both the DA and the DP groups than in the control group. Ten (9.8%) of the panic disorder patients fulfilled the diagnostic criteria for DP; 31 (30.4%) had severe DA. In the control group, none of the patients was diagnosed as DP, whereas 7 (13.5%) had severe DA. Panic disorder and DA both responded to the antidepressant treatment, but DAS scores remained significantly higher in the DP group than in the DA group and the control group at the end of the third month.

CONCLUSIONS

Our data suggest that both DA and DP are more frequent in panic disorder than in healthy controls. Antidepressant treatment may have been helpful in decreasing DA levels in the DA group but not in the DP group.

Need and demand for sedation or general anesthesia in dentistry: a national survey of the Canadian population

The aim of this study was to assess the need and demand for sedation or general anesthesia (GA) for dentistry in the Canadian adult population. A national telephone survey of 1101 Canadians found that 9.8% were somewhat afraid of dental treatment, with another 5.5% having a high level of fear. Fear or anxiety was the reason why 7.6% had ever missed, cancelled, or avoided a dental appointment. Of those with high fear, 49.2% had avoided a dental appointment at some point because of fear or anxiety as opposed to only 5.2% from the no or low fear group. Regarding demand, 12.4% were definitely interested in sedation or GA for their dentistry and 42.3% were interested depending on cost. Of those with high fear, 31.1% were definitely interested, with 54.1% interested depending on cost. In a hypothetical situation where endodontics was required because of a severe toothache, 12.7% reported high fear. This decreased to 5.4% if sedation or GA were available. For this procedure, 20.4% were definitely interested in sedation or GA, and another 46.1% were interested depending on cost. The prevalence of, and preference for, sedation or GA was assessed for specific dental procedures. The proportion of the population with a preference for sedation or GA was 7.2% for cleaning, 18% for fillings or crowns, 54.7% for endodontics, 68.2% for periodontal surgery, and 46.5% for extraction. For each procedure, the proportion expressing a preference for sedation or GA was significantly greater than the proportion having received treatment with sedation or GA (P < 0.001). In conclusion, this study demonstrates that there is significant need and demand for sedation and GA in the Canadian adult population.

Behavioural science in dentistry. The role of the dental hygienist in prevention and treatment of the fearful dental patient

The prevalence of dental anxiety in the general population seems to be fairly stable, and the incidence is not reduced in spite of more modern treatment methods. Intensive fear often leads to avoidance of care and consequences like poor oral health, psychosocial problems and reduced quality of life. The aetiology of dental anxiety is complex, but is often associated with direct traumatic dental experiences during childhood. These negative experiences are reported as painful/unpleasant and are influenced by the patient's perception of lack of coping and control. The theory of latent inhibition indicates that several positive dental appointments before any invasive or painful treatment sessions may act as a barrier to these perceptions of lack of coping. This paper is presenting a short overview of behavioural science in dentistry and discussing the role of the dental hygienists as potential key personnel in prevention and treatment of dental anxiety.

Attentional and physiological characteristics of patients with dental anxiety

Twenty patients with dental anxiety were investigated while seated in a dental chair in a dental clinic. Heart rate (HR), heart rate variability (HRV), and skin conductance level (SCL) were recorded while the patients were exposed to scenes of dental treatment as well as a Stroop attentional task. Results showed an attentional bias with longer manual reaction times (RT's) to the incongruent compared to the congruent color words as well as the threat compared to the neutral words. Longer RT's to the incongruent and the threat words were found in the low HRV patients compared to the high HRV patients. Furthermore, all patients showed an increase in HR during exposure and the Stroop task compared to baseline. The HRV showed a decrease during the exposure and the Stroop task compared to baseline. HR and HRV did not differ between exposure and the Stroop task. Moreover, HR and HRV did not return to baseline levels during the recovery period. The SCL showed an increase from baseline to exposure, from exposure to the Stroop task and a decrease in the recovery phase. Results showed the importance of vagal cardiac control in attentional, emotional, and physiological processes in patients suffering from dental fear.

Are there differences in oral health and oral health behavior between individuals with high and low dental fear?

Epidemiological studies of the relationship between dental fear, use of dental services, and oral health in different age groups in a common population are scarce. Dental fear and its relationships are usually described in individuals with high dental fear only. The purposes of this study were to describe the prevalence of dental fear in the Norwegian adult population according to age, and to explore differences in oral health, oral hygiene, and visiting habits between individuals with high and low dental fear. For the present study, data from the Trøndelag-94 study were used. The prevalence of dental fear in our study population of adults in Trøndelag, Norway was 6.6%. There was a tendency for individuals with high dental fear to engage in avoidance behavior more frequently than the low dental fear group. Individuals with high dental fear had a statistically significantly higher number of decayed surfaces (DS), decayed teeth, (DT) and missing teeth (MT) but a statistically significantly lower number of filled surfaces (FS), filled teeth (FT), functional surfaces (FSS), and functional teeth (FST). There were no differences in DMFS and DMFT between the groups of high and low dental fear. Since one of the superior aims of the dental profession is to help a patient to achieve a high number of functional teeth throughout life, consequently detecting and treating dental fear should therefore be an important aspect of dental processionals' work.

Number of teeth, body mass index, and dental anxiety in middle-aged Swedish women

Risk factors for poor dental health include obesity, low socio-economic status, poor dietary habits, and dental anxiety. The aim of this study was to explore the complex relation between body mass index (BMI) and number of teeth in middle-aged women taking education, dietary intake patterns, dental care utilization, and dental anxiety into account. Three groups of women (37-60 years): reference women (group I, BMI 23.8 +/- 3.1 kg/m2), obese women (group II, BMI 35.0 +/- 2.6 kg/m2), and severely obese women (group III, BMI 41.0 +/- 3.4 kg/m2) were included. Questionnaires were used to assess education, smoking, number of teeth, dental care utilization, dental anxiety, dietary intake, and meal patterns. Age, education, and smoking habits did not differ significantly between groups. However, there were significant global differences in number of teeth (27.2 +/- 3.4, 23.0 +/- 9.2, 24.7 +/- 5.9) and reported daily energy intake (9756 +/- 3363 kJ, 10344 +/- 3850 kJ, 11970 +/- 3786 kJ in groups I, II, and m, respectively). In a multiple regression model, a lower number of teeth was independently associated with higher age, higher BMI, lower education, irregular dental care, high dental anxiety, higher energy intake, and lower iron intake. These variables explained 25% of the variation in number of teeth. In conclusion, BMI is an independent predictor of number of teeth in middle-aged women when socio-economic, dietary, and psychological factors are taken into account.

Dental anxiety in relation to mental health and personality factors. A longitudinal study of middle-aged and elderly women

Little is known about the longitudinal course of dental anxiety in relation to age, mental health and personality factors. In 1968 69 a representative sample of 778 women aged 38 to 54 yr took part in a psychiatric examination. Three hundred and ten were followed up in 1992-93. A phobia questionnaire, including assessment of dental fear, and the Eysenck Personality Inventory were distributed to the participants at both occasions. High dental fear was reported by 16.8% of the women at baseline and was associated with a higher number of other phobias, a higher level of neuroticism, more psychiatric impairment, more social disability due to phobic disorder, and a higher anxiety level. Among women who reported high dental fear in 1968 69 (n=36), 64% remitted and 36% remained fearful. Among women with low dental fear in 1968 69 (n = 274), 5% reported high dental fear in 1992-93. Chronicity was associated with higher neuroticism, lower extraversion, and more psychiatric impairment at base-line. Remission was associated with higher extraversion at baseline. Dental anxiety increased or decreased over time in concert with the number of other fears.

Factors associated with dental anxiety among older people in Britain

OBJECTIVE

This paper reports on a study of dental anxiety among adults aged 60 years living independently in Britain.

DESIGN

A national cross-sectional study carried out with the assistance of the Office for National Statistics' Omnibus Surveys in 1999.

SETTING

Data was collected by face to face interviews with older people in their homes.

MEASUREMENTS

Data on dental anxiety were collected from 973 subjects by means of face to face interviews and was measured by the Dental Anxiety Scale (DAS) (Corah, 1969). In addition, data on dental service use and oral health status (self-reported) was collected.

RESULTS

The mean DAS score was 8.4 (sd 3.5), and 13% (129) of subjects were classified as dentally anxious (DAS > or = 13). DAS scores were associated with numerous socio-demographic factors (P < 0.01), self-reported oral health status (P < 0.01) and dental service (P < 0.01) factors. A series of regression analyses revealed that dental anxiety was a significant predictor of a number of behavioural and oral health outcomes.

CONCLUSION

One in eight older people in Britain are dentally anxious and this is associated with their use of services and oral health status (self-reported).

Non-institutionalized elderly dental patients in Israel: socio-demographics, health concerns, and dental anxiety

The purpose of this study was to evaluate which factors might influence health care attitudes such as anxiety about dental care by older adults in Israel. The study population consisted of 103 non-institutionalized patients (46 men and 57 women) over the age of 65 who attended a dental clinic that provided services for older adults during a one-year period. Socio-demographic information and information about the subjects' general health and their level of concern about health problems were obtained from self-reported questionnaires, while the dental anxiety level was found by means of a dental anxiety scale (DAS). Ninety-nine percent of the patients suffered from a major systemic disease such as diabetes, hypertension, atherosclerosis, respiratory disease, and rheumatic disease. Both unmarried and first-time patients expressed high anxiety scores. Patients with 12 or fewer years of formal schooling demonstrated significantly higher dental anxiety. Among patients who regularly attended a synagogue or a social club, concern about oral health was significantly higher than for the rest (p < 0.02). No association was found between having dentures and gender, or between having dentures and level of education. The reason for visiting the clinic (inability to eat, pain, or esthetics) was not associated with any other health concern or with dental anxiety levels. This study determined that patients who were unmarried, less educated, or attending the facility for the first time were more likely to experience dental anxiety. These patients merit special consideration.

Variations in dental anxiety among middle-aged and elderly women in Sweden: a longitudinal study between 1968 and 1996

Cross-sectional studies have shown that older individuals are significantly less dentally anxious than younger ones. However, research has not been able to show if this is a cohort effect or an effect of fear declining with age. If it is a cohort effect, dental anxiety among the elderly may pose a greater-than-expected problem for the providers of dental services. With the exception of longitudinal studies in children and a three-year follow-up on adults, no truly longitudinal epidemiological studies concerning dental anxiety have been performed. The aim of this project was to investigate how dental anxiety changes with aging. In a longitudinal population study of women in Göteborg, Sweden, starting in 1968, 1462 women aged 38 to 54 participated. A representative subsample of 778 women took part in a psychiatric examination where an investigation of dental anxiety was included. The same questions were also included when these women were re-examined in 1974, 1992, and 1996. Three hundred seventy-five women were still eligible for investigation in 1996. In 1968-69, 48 (12.8%) of the participating women assessed themselves as "very afraid" or "terrified" when visiting the dentist, and in 1996 the frequency was 21 (5.6%) among the same women. In 1968-69, 180 women (48%) reported no dental anxiety when visiting the dentist, and 28 years later the frequency was 230 (61%). In the three youngest age groups, dental anxiety decreased significantly (p < 0.001) over the 28-year period. Older compared with younger women reported significantly less dental anxiety, and this was an age effect rather than a cohort effect. Thus, this longitudinal study supported the hypothesis that dental fear, like many other general and specific phobias, declines with age.